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Larry  Laughlin 


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MILITARY  HYGIENE 


THE  ELEMENTS  OF 
MILITARY  HYGIENE 

ESPECIALLY  ARRANGED  FOR  OFFICERS 
AND  MEN  OF  THE  LINE 


BT 

P.  M.  ASHBURN 

MAJOR,  MEDICAL  CORPS,  U.  S.  ARMT 


g5^^aas5 


BOSTON  AND  NEW  YORK 
HOUGHTON  MIFFLIN  COMPANY 


COPyiUGHT,   1909  AND   I915,    BT  PKRCY  M.   ASHBURN 
ALL   RIGHTS   RSSERVED 


600 

1915 
PREFACE  TO  THE  SECOND  EDITION 

Since  the  first  appearance  of  this  book  there  has  been 
a  notable  and  gratifying  increase  in  the  interest  that 
line  officers  and  men  have  manifested  in  matters  of 
hygiene  and  sanitation,  and  a  corresponding  increase 
in  the  effectiveness  of  disease  -  preventing  measures. 
That  this  improvement  has  occurred  is  not  necessarily 
^  evidence  that  the  book  has  been  instrumental  in  bring- 
<  ing  it  about,  but  expressions  of  opinion  from  various 
SB  officers  have  led  me  to  think  it  a  possible  factor,  and 
z  have  in  that  way  encouraged  me  to  revise  and  in  parts 
rewrite   it,  while  a   supplementary  chapter  has   been 
added,  in  the  belief  that  interest  in  the  subject  entitles 
the  reader  to  a  knowledge  of  advances  more  recently 
made,  and  in  the  hope  that  such  interest  and  the  use- 
fulness of  the  book  may  ba  increased. 
December  8,  1914. 


C3 

3 


346655 


PREFACE 

There  can  be  little  or  no  doubt  that  the  sanitation  of 
the  army  would  be  greatly  improved  if  line  officers 
and  enlisted  men  should  become  more  interested  in  the 
subject,  and  cooperate  more  freely  and  intelligently 
with  medical  officers  in  the  efforts  to  promote  it. 

This  book  is  written  in  the  hope  that  it  may  both 
inform  and  interest  them  and  so  gain  for  the  medical 
officer  the  sympathy  and  cooperation  that  he  always 
needs,  but  now  too  seldom  has.  It  is  also  hoped  that 
medical  officers  themselves,  especially  those  of  the 
volunteer  service  and  militia,  may  find  the  book  useful 
in  their  dual  capacities  of  administrators  and  teachers. 


CONTENTS 

PART  I.— THE  RECRUIT  AND  HIS  ENVIRON- 
MENT 

I.  The  Recruit 3 

II.  Personal  Hygiene 20 

III.  Foods  and  their  Preparation    .        .        .32 

IV.  The  Hygiene  of  the  Barracks       .        .        54 
V.  Camps 73 

VI.  The  Hygiene  of  Moving  Troops     .        .      103 
VII.  The  Hygiene  of  Hot  and  Cold  Climates  122 

PART  IL  — THE  CAUSES  OF  DISEASE 

Vni.  The  Remote   or  Predisposing   Causes  op 

Disease 147 

IX.  The    Immediate    or    Exciting    Causes    of 

Disease 162 

X.  Disease-Carriers 187 

PART  III.  — THE  PREVENTION  AND 
CONTROL  OF  EPIDEMICS 

XI.  The  Defenses  against  Disease  in  General  207 
XII.  Diseases   due  to   Infection   through  the 

Alimentary  Tract         ....      223 
XIII.  Diseases   due   to   Infection   through   the 

Respiratory  Tract   .....  255 


viii  CONTENTS 

XIV.  Insect-Bobnb  Diseases 275 

XV.  Venereal  Diseases 312 

SUPPLEMENT 

XVI.  The  Prevention  of  Mental  and  Nervous 

Diseases 335 

Index  .        .  .        .        ,        .      345 


PART  r 

THE  RECRUIT  AND  HIS 
ENVIRONMENT 

••  Health  and  a  good  constitution  are  better  than  all  gold ;  and  a 
strong  body  than  wealth  without  measure." 

EccLESiASTicus  30 :  15. 


MILITARY  HYGIENE 

CHAPTER  I 

THE  RECRUIT 

One  of  the  principal  factors  in  military  hygiene  is 
the  individual  soldier,  or,  as  he  comes  from  civil  life, 
the  recruit.  If  he  enters  the  service  in  good  physical 
condition,  in  good  health,  and  with  sufficient  intelli- 
gence to  apprehend  and  apply  the  instruction  he  re- 
ceives in  military  hygiene,  the  problem  is  almost  half 
solved.  The  final  acceptance  or  rejection  of  recruits  now 
rests  almost  entirely  with  medical  officers ;  but  in  cer- 
tain ways  line  officers  exercise  a  considerable  influence 
in  the  matter :  in  the  acceptance  at  the  recruiting  station, 
and  in  requesting  special  authority  to  enlist  because  of 
special  qualifications.  For  these  and  other  reasons  it  is 
important  that  they  should  keep  well  informed  as  to  the 
requirements  necessary  and  the  qualifications  desirable  in 
recruits.  We  will  therefore  briefly  consider  some  of  these. 
The  age  limits  for  first  enlistments  are  from  eighteen 
to  thirty-five  years.  Preferably  men  should  be  chosen 
between  twenty-three  and  thirty  years.  Be- 
fore  the  age  of  twenty-three  years  most  ° 
men  are  immature,  their  muscles  are  not  hardened,  their 
hearts  not  so  strong,  their  minds  not  disciplined  by  expe- 
rience, their  appetites  and  emotions  not  under  control ; 
while  their  susceptibility  to  impressions  from  their  en- 
vironment is  such  as  to  make  it  undesirable  to  limit 
their  associations  exclusively  to  adult  unmarried  males. 


4    THE  RECRUIT  AND  HIS   ENVIRONMENT 

After  the  age  of  thirty  years  the  man's  habits  of  body 
and  mind  are  fixed,  he  takes  instruction  less  readily, 
his  body  may  have  begun  to  deteriorate,  particularly  if 
it  has  not  been  well  cared-for,  and,  in  many  instances, 
he  seeks  the  service  as  a  refuge,  after  failing  in  other 
walks  of  life.  Many  good  men  may  be  obtained  before 
the  age  of  twenty-three  and  between  the  ages  of  thirty 
and  thirty-five,  but  in  general  the  case  is  thought  to 
be  as  stated. 

The  size  of  the  recruit  is  not  a  matter  of  the  great- 
est importance,  provided  that  the  development  is  nor- 
mal  and  the  man  strong  and  active,  except 
as  it  applies  to  assigning  him  to  duty.  It 
is  obvious  that  a  very  large  and  strong  man  is  better 
suited  for  coast-artillery  work  than  for  the  cavalry,  and 
that  a  small,  wiry  man  is  in  that  respect  better  for  the 
cavalry.  The  proportions  of  weight  and  chest  measure- 
ments to  height  are  published  from  time  to  time  in 
general  orders,  and  those  proportions  usually  represent 
very  well  those  of  strong,  well-developed  men.  An  in- 
crease of  weight,  if  associated  with  great  breadth  of 
shoulder  and  large  chest  measurement,  is  not  necessarily 
harmful,  being  usually  indicative  of  strength  and  en- 
durance. The  sturdy,  stocky  Japanese  coolie  exemplifies 
this.  Obesity,  whereby  the  man  is  burdened  with  his 
own  weight,  is  of  course  objectionable.* 

^  The  following  table  copied  from  the  Medical  Record  of  September 
5,  1908,  and  compiled  from  the  data  of  the  Mutual  Life  Insurance  Co. 
of  New  York,  by  its  Chief  Medical  Director,  is  interesting  as  indicat- 
ing somewhat "  the  influence  of  overweight  and  underweight  on  vitality." 
The  weights  considered  normal  by  the  insurance  company  are  some- 
what in  excess  of  those  prescribed  by  the  War  Department,  the  in- 
crease averaging  about  10  pounds  at  the  ages  25-29,  and  for  height* 


THE  RECRUIT 


The  chest  should  be  freely  mobile,  that  is,  both  sides 
should  move  freely,  symmetrically,  and  equally,  in  ex- 
panding and  contracting.  The  measured 
chest  expansion  should  generally  corre- 
spond with  the  figures  published  in  the  general  orders; 
yet  it  should  be  remembered  that  one  man  with  very 
ordinary  lung  capacity  may,  by  use  of  the  shoulder  and 

below  70  inches.  A  weight  20  per  cent  below  the  average  is  considered 
"  underweight,"  and  20  per  cent  above  the  average,  "overweight." 

Table  showing  the  Percentage  of  Deaths  in  all  Classes,  and  some  Indi- 
vidual Diseases,  among  Overweights  and  Underweights,  and  the 
General  Experience  of  the  Mutual  Life  Insurance  Company. 


Causei  of  Death. 


Over- 

Under- 

weights. 

teeightt. 

9.67 

9.28 

4.00 

3.06 

1.27 

1.21 

1.47 

2.04 

13.07 

24.59 

2.93 

16.98 

4.40 

5.57 

3.40 

0.65 

19.08 

12.16 

14.14 

8.47 

1.80 

0.84 

16.01 

11.69 

12.94 

8.54 

8.54 

15.78 

6.87 

12.34 

10.61 

8.54 

3.47 

0.65 

12.01 

7.42 

11.07 

5.30 

1.20 

0.47 

None 

2.04 

7.07 

5.57 

4.20 

3.43 

2.87 

2.14 

2.60 

2.50 

General 
Experience, 


Class  I.  General  Diseases  —  Acute    .     . 

Typhoid  fever 

Malarial  fever 

Influenza 

CImb  II.       General  Diseases  —  Chronic 

Tuberculosis 

Cancer    ....  ... 

Diabetes 

Class  III.      Diseases  of  the  Nervous  System 

Cerebral      Congestion       and 

Hemorrhage,  Cerebral 

Softening,  Paralysis   .     . 

General  Paralysis  and  other 

forms  of  mental  alienation 

Class  IV.      Diseases     of    the    Circulatory 

System 

Organic  diseases  of  the  heart 
Class  V.        Diseases    of    the    Respiratory 

System 

Pneumonia 

Class  VI.      Diseases  of  the  Digestive  Sys- 
tem       

Cirrhosis  of  Liver     .... 
Class  VII.     Diseases  of  the  Genito-urinary 

System 

Bright's  Disease  and  Nephri- 
tis    

Class  IX.      Diseases  of    Skin  and  Cellular 

Tissue 

Class  XI.      Old  age 

Class  XII.    Violent  causes 

Casualties 

Suicides       

Class  Xin.  Ul-defined 


8.90 

3.94 

1.24 

1.00 

19.56 

12.42 

4.18 

1.25 

17.44 


12.32 

1.30 

1185 
10.76 

11.86 
9.03 

10.19 
1.00 

8.78 

6.66 

0.50 
1.50 
7.42 
6.21 
2.20 
3.98 


6    THE  RECRUIT  AND  HIS  ENVIRONMENT 

back  muscles  and  retraction  of  the  abdomen,  show  an 
apparent  expansion  of  3^  inches,  while  his  companions 
with  a  capacity  as  great,  may,  through  ignorance  of 
tricks  or  of  what  is  desired,  show  only  1|  inches.  It  is 
desirable  that  the  chest  be  fairly  large,  to  afford  ample 
room  for  the  free  working  of  the  heart  and  lungs,  as  on 
such  finally  depend  both  strength  and  endurance.  A 
generally  well-developed  and  strong  man  will  show 
well-developed  and  prominent  chest  muscles. 

Certain  types  of  chest  frequently  indicate  a  predis- 
position to,  or  the  actual  existence  of,  disease,  and  de- 
mand careful  consideration  even  when  not  constituting 
actual  causes  for  rejection.  The  long,  narrow  chest,  with 
prominent  or  "  winged  "  shoulder-blades,  depressed  or 
flat  below  the  collar-bones,  and  forming  an  acute 
angle  at  the  divergence  of  the  ribs  below  the  breast- 
bone, frequently  marks  a  predisposition  to  consumption, 

A  large,  barrel-shaped  chest,  as  deep  from  front  to 
back  as  transversely,  and  showing  a  relatively  small 
movement,  is  often  associated  with  emphysema  and 
asthma. 

A  chest  more  prominent  on  one  side  than  on  the 
other  is  apt  to  be  associated  with  curvature  of  the  spine, 
or  old  or  chronic  pleurisy. 

Marked  prominence  or  depression  of  the  breast-bone, 
especially  if  associated  with  "beading,"  or  lumps  on 
the  ribs  near  the  breast-bone,  frequently  results  from 
rickets,  and  may  be  accompanied  by  other  bone  de- 
formities. 

The  abdomen  should  be  well  muscled,  and  firm  when 

...  the  applicant  is  standing.   It  should  move 

easily  and  naturally  in  respiration,  should 

not  be  pendulous,  and  should  be  firm,  particularly  in 


THE  RECRUIT  7 

its  lower  parts,  just  above  the  groin.  "Weakness  here 
will  be  indicated  by  a  bulging  if  the  patient  strains,  as 
at  stool,  or  if  he  stands  on  his  toes  and  coughs  hard. 
Such  bulging,  especially  if  it  be  marked  or  shows  a 
tumor-like  swelling,  indicates  a  predisposition  to,  or 
the  actual  existence  of,  a  hernia. 

The  umbilicus  or  navel  is  another  frequent  site  of 
hernia,  and  should  be  noted  in  that  connection,  as 
should  any  abdominal  scars  resulting  from  operations, 
as  for  appendicitis.  Another,  though  less  frequent,  site 
of  hernia  is  the  femoral.  This  is  shown  by  a  fullness 
or  swelling  in  the  lower  part  of  the  groin,  in  the  high- 
est part  of  the  thigh  rather  than  in  the  lowest  part  of 
the  abdomen. 

Large  masses  or  tumors  that  can  be  felt  through  the 
abdominal  wall,  or  that  can  be  seen  to  produce  in- 
equality or  fullness,  are  causes  for  rejection. 

Distention  or  prominence  of  the  veins  on  the  sur- 
face of  the  abdomen,  or  a  varicose  condition  of  them,  is 
generally  an  evidence  of  impaired  circulation  or  liver 
disease,  and  should  cause  rejection. 

Hemorrhoids,  or  piles,  while  apparently  not  con- 
nected with  the  abdomen,  are  the  result  of  distention 
of  the  rectal  veins,  and  may  be  due  to  liver  disease,  to 
abdominal  tumors,  to  constipation,  or  other  intra-ab- 
dominal conditions.  They  are  manifested  as  tumors, 
usually  of  a  bluish  color,  within  or  about  the  anus,  which 
vary  in  size  from  that  of  a  small  pea  to  that  of  a  man's 
thumb.  Of  themselves  they  are  not  a  cause  for  rejection 
unless  of  large  size  or  producing  symptoms,  but  their 
presence  should  always  be  noted.  Internal  piles  are  not 
visible,  and  usually  make  their  presence  known  by  burn- 
ing or  irritation  in  the  rectum,  or  by  the  passage  of 


8    THE  RECRUIT  AND   HIS  ENVIRONMENT 

blood  in  the  stools.  In  examining  for  them,  note  should 
also  be  made  of  other  abnormal  conditions  of  or  about 
the  anus,  such  as  fissures  or  cracks  in  the  skin  and 
mucous  membrane ;  fistulas,  little  openings  near  the 
anus  from  which  there  may  be  a  slight  discharge  of  pus 
or  fecal  matter ;  or  abscesses  or  boils.  Any  of  these 
conditions  may  so  disable  the  man  as  to  unfit  him  for 
service. 

A  history  of  abdominal  trouble,  such  as  severe  indi- 
gestion»  gallstone  colic,  vomiting  of  blood,  should  cause 
rejection. 

The  examination  of  the  head  is  very  important,  as 
revealing  defects  in  most  of  the  special  senses  and  as 
_,     J  offering  important  evidence  as  to  the  man's 

character,  habits,  and  abilities.  The  evi- 
dence on  the  latter  points  is  to  be  gained  largely  from 
the  shape  of  the  head  and  the  expression  of  the  features, 
and,  while  such  evidence  is  not  always  reliable,  certain 
heads  and  faces  are  so  distinctly  indicative  of  stupidity 
or  vice  that  there  should  be  no  hesitation  in  rejecting 
their  possessors.  Then,  too,  hideous  or  disgusting  de- 
formities should  at  once  cause  rejection,  for  the  sake 
both  of  the  victim  and  those  with  whom  enlistment 
would  associate  him,  even  though  they  are  not  of  a 
character  to  incapacitate  directly.  The  vision  and  hear- 
ing should  be  tested  in  strict  accordance  with  the  regu- 
lations governing  the  subject,  and  failure  to  meet  the 
requirements  is  cause  for  rejection. 

In  addition  to  the  test  for  vision,  however,  the  eyes 

should  be  examined  for  any  signs  of  inflammation,  red- 

-j  ness,  watering,  drooping  of  the  lids,  scars 

or  deformities,  granulations,  styes  or  boils, 

undue  prominence  of  the  eyeball,  inability  to  move  the 


THE  RECRUIT  9 

eyes  in  all  directions,  and  discoloration  or  blurring  of 
the  cornea. 

The  ears,  in  addition  to  the  testa  for  hearing,  should 
be  examined  for  any  discharge,  whether 
watery  or  puinilent,  and  if  present  it  should 
be  a  cause  for  rejection. 

The  nose  should  be  examined  as  to  its  freedom  from 
obstruction,  by  having  the  applicant  close  first  one  side 
and  then  the  other  with  his  fingers  and  then 
breathe  and  blow  through  the  free  side.  In- 
cidentally this  may  call  attention  to  a  foul-looking  dis- 
charge or  a  foul-smelling  breath,  either  of  which  may 
justify  rejection.  A  sunken  or  much  scarred  nose  is 
often  an  indication  of  syphilis,  while  a  red,  bulbous 
nose,  even  if  not  indicating  alcoholism,  is  sometimes  an 
indication  of  indigestion.  It  should  be  noticed  that  the 
man  habitually  breathes  through  his  nose. 

The  mouth  and  throat  should  always  be     __ 
r  n  •     J  Mouth 

carefully  examined. 

The  condition  of  the  teeth  is  the  first  point  to  be 
noted  here.  It  is  desirable  that  all  should  be  pre- 
sent and  good,  but  there  must  be  at  least  . 
enough  to  permit  of  proper  mastication  of 
the  food,  and  for  this  purpose  at  least  four  grinders 
are  demanded,  two  above  and  two  below,  and  so  dis- 
posed as  to  permit  their  effective  use.  Enough  of  the 
front  teeth  should  also  be  present  to  permit  of  the  bit- 
ing of  food  and  to  preserve  the  symmetry  of  the  face. 
At  times  men  are  accepted  with  no  upper  teeth,  but 
wearing  plates.  This  should  only  be  done  by  special 
authority  and  in  special  instances.  Insufficient  or  poor 
teeth  are  apt  to  produce  digestive  disturbances,  partic- 
ularly on  campaign,  when  hard  bread  may  be  issued, 


10    THE  RECRUIT  AND  HIS  ENVIRONMENT 

and  when  the  preparation  of  the  food  in  general  may 
not  be  as  good  as  in  garrison.  The  examination  of  the 
teeth  should  not  only  relate  to  their  presence  and  the 
presence  or  absence  of  cavities,  but  also  to  their  state 
of  cleanliness.  Neglected,  filthy  teeth  and  gums  may 
seriously  menace  the  general  health,  while  they  cer- 
tainly predispose  to  loss  of  teeth,  and,  in  many  instances, 
indicate  general  carelessness  or  filthiness.  Sores  or 
ulcerations  on  the  lips,  tongue,  gums,  or  inner  sides  of 
the  cheeks  should  be  carefully  noted,  as  they  may  in- 
dicate syphilis  or  other  general  disease,  and  should  at 
least  lead  to  further  and  more  careful  search  for  syphi- 
lis. The  same  remark  applies  to  milk-white  patches, 
seen  especially  on  the  tongue. 

In  ill-kept  mouths  the  gums  may  be  spongy  and  bleed 

spontaneously  or  on  pressure,  or  pus  may  exude  from 

_,  between  them  and  the  teeth ;  or  they  may 

be  greatly  retracted  and  expose  the  roots 

of  the  latter. 

In  these  and  other  cases  the  teeth  may  all  be  present, 
yet  in  such  poor  condition  as  to  forbid  proper  mastica- 
tion, or  to  threaten  their  early  loss. 

The  most  common  and  easily  detected  throat  trouble 
is  enlargement  of  the  tonsils.  This  condition  usually 
__  indicates  a  liability  to  frequent  attacks  of 

sore  throat,  and  should  always  excite  in- 
quiries as  to  this,  and  while  not  necessarily  a  cause  for 
rejection,  unless  very  marked,  should  be  noted  as  a 
point  against  desirability.  Ulcers,  white  patches,  mem- 
branes, and  an  appearance  of  acute  inflammation  in 
the  throat,  should  cause  rejection. 

Hoarseness,  or  loss  of  voice,  or  cough,  should  at  least 
delay,  and  if  persistent  prevent,  acceptance. 


THE  RECRUIT  11 

Numerous  scars  on  the  tongue,  lips,  and  cheeks,  unless 
clearly  and  certainly  accounted  for  other- 
wise,  should  cause  rejection  as  being  prob-  ° 

ably  due  to  bites  during  epileptic  fits,  or  to  syphilitic 
or  other  ulceration. 

Too  much  importance  should  not  be  attached  to  a 
coated  tongue,  but  a  raw-looking,  bright  red,  or  tremu- 
lous one  should  direct  careful  scrutiny  to  the  general 
condition  and  the  habits. 

Enlarged  lymphatic  glands,  or  "  kernels,"  are  most 
frequently  noticed  in  the  neck  or  under  the  jaw.    They 
are  frequently  indicative  of  inflammation  or     » 
ulceration  in  other  nearby   regions,  espe- 
cially  the  mouth  or  throat,  and  their  pre-     ^ 
sence  should  lead  to  careful  examination  for  such  con- 
ditions ;  but  at  times  their  presence  is  indicative  of  a 
general  infection,  such  as  syphilis.   Usually,  if  the  en- 
larged glands  are  numerous,  or  the  enlargement  great, 
they  constitute  a  proper  cause  for  rejection.  When  the 
enlargement  is  localized  at  one  part  of  the  neck  only, 
it  points  to  an  infection  entering  at  a  part  near  it. 
Thus  such  a  gland  at  the  angle  of  the  jaw  may  be  due 
to  inflammation  of  a  tonsil  of  the  same  side  ;  one  under 
and  near  the  jaw  to  a  bad  tooth,  etc. 

The  scalp  should  be  carefully  examined  as  to  its 
cleanliness  and  general  care,  for  the  presence  of  lice, 
which  may  be  seen  as  such  or  may  be  re-  • 
vealed  by  the  "  nits  "  or  eggs,  little  whitish 
bodies  attached  firmly  to  the  hairs ;  for  ringworm, 
scabbiness  or  scald-head,  patchy  baldness,  wounds  or 
scars,  etc.  The  presence  of  vermin  is  a  cause  of  rejec- 
tion in  two  ways,  as  indicating  a  lack  of  personal  care, 
and  as  a  danger  to  be  introduced  into  crowded  barracks. 


12    THE  RECRUIT  AND  HIS  ENVIRONMENT 

Superficial  suppurative  scalp  diseases  should  generally 
cause  rejection,  as  being  contagious  or  as  being  caused 
by  scratching  excited  by  lice.  Patchy  baldness,  if  the 
patches  are  sharply  defined  and  the  skin  is  smooth, 
clean-looking,  and  not  scarred,  is  apt  to  be  harmless. 
If  the  skin  is  infiamed  and  scarred,  and  stumps  of 
broken  hairs  are  present,  it  should  cause  rejection.  Ir- 
regular and  incomplete  baldness  occurring  in  patches 
or  tracts,  giving  at  times  a  "  moth-eaten  "  appearance, 
is  most  apt  to  be  due  to  syphilis,  and  should  cause  care- 
ful examination  for  other  signs  of  that  disease. 

The  upper  limbs  should  be  examined  as  to  their  de- 
velopment and  musculature,  their  free  mobility  in  all 
joints  and  in  all  directions,  the  presence  of 
all  bones  and  joints,  and  a  reasonable 
amount  of  dexterity  and  strength.  Atrophy  or  wasting 
of  a  group  of  muscles  or  a  part,  inability  to  bend  or 
make  free  use  of  a  joint,  and  similar  defects,  should 
be  carefully  looked  for,  as  they  may  otherwise  be 
missed.  Loss  of  one  or  more  joints  of  a  finger,  swelling 
and  deformity  of  a  joint  (baseball  finger),  or  stiff  con- 
tracted fingers  are  not  uncommon,  and,  if  in  the  fourth 
or  fifth  fingers,  are  not  serious  matters,  though  they 
should  be  noted.  If  in  the  second  or  third  fingers,  the 
matter  is  more  serious,  yet  the  applicant  will  usually 
be  able  to  handle  a  gun  and  perform  his  other  duties. 
Loss  of  a  thumb  is  a  serious  defect,  and  in  most  instances 
would  justify  rejection.  All  deformities  from  badly 
united  fractures  or  other  causes  should  be  noted,  and 
should  cause  rejection  unless  the  applicant  can  demon- 
strate his  ability  to  execute  the  movements  necessary 
in  the  performance  of  his  duties. 

The  legs  should  likewise  be  examined  as  to  their 


THE  RECRUIT  13 

development,  musculature,  size,  mobility,  etc.  The  ap- 
plicant should  be  required  to  move  all  the  t  g^g  ^j,  j 
joints,  to  jump,  hop,  and  otherwise  demon- 
strate  his  ability  to  use  his  limbs.  Marked 
deformities,  such  as  clubfoot,  shortening  of  one  leg, 
stiffness,  marked  swelling  or  marked  limitation  of  mo- 
tion in  a  knee  or  hip,  should  at  once  cause  rejection. 
Less  marked  deformities,  such  as  knock-knee,  bow-legs, 
crooked  shins,  etc.,  need  not  cause  rejection  unless  man- 
ifestly interfering  with  the  free  use  of  the  limbs,  or 
rendering  the  subject's  appearance  ludicrous  or  unmili- 
tary.  Here,  again,  marked  wasting  of  a  part  or  of  a 
group  of  muscles  will  often  be  found  due  to  a  joint 
lesion,  a  paralysis,  or  other  nervous  trouble,  that  would 
serve  to  disqualify  the  applicant.  In  addition  to  these 
defects,  common  to  both  arms  and  legs,  the  lower  ex- 
tremities are  subject  to  other  affections  rarely  or  never 
seen  in  the  upper. 

Varicose  or  dilated  veins  are  often  seen.  They  usu- 
ally show  as  swollen,  bluish,  and  more  or  less  tortuous 
vessels  beneath  the  skin,  and  may  be  individually  as 
large  as  a  man's  finger.  They  are  most  commonly  seen 
on  the  lower  legs,  but  are  not  very  rare  in  the  space  be- 
hind the  knee,  and  may  extend  up  the  inner  side  and 
front  of  the  thigh  to  the  groin.  If  marked,  they  should 
caiase  rejection.  If  only  slight,  and  in  otherwise  desira- 
ble applicants,  they  may  be  passed,  but  should  always 
be  noted.  At  times  they  cause  the  appearance  and  per- 
sistence of  very  chronic  ulcers,  which  occasionally  bleed, 
pain,  or  otherwise  disable  the  man.  Such  ulcers  are  es- 
pecially apt  to  show  on  the  front  or  to  the  inner  side  of 
the  lower  half  of  the  leg.  They  are  long  in  healing,  are 
apt  at  any  time  to  break  open  again,  and  when  healed 


14    THE  RECRUIT  AND  HIS  ENVIRONMENT 

usually  present  brownish,  discolored  scars.  Such  ulcers, 
or  such  scars  if  accompanied  by  varicose  veins,  should 
cause  rejection.  The  legs  are  especially  prone  to  chronic 
ulcerations^  which  may  be  caused  by  syphilis,  tubercu- 
losis, leprosy,  and  other  infections.  In  general  these  are 
causes  for  rejection. 

A  rough,  nodulated,  tender  shin-bone  is  not  an  un- 
usual sign  of  syphilis. 

The  feet  require  particularly  careful  examination,  as 
on  their  integrity,  usefulness,  and  strength  (or  what  we 
might  call  their  durability)  depends  a  large  part  of  the 
man's  capacity  for  "  soldiering."  The  best  known  and 
probably  the  least  important  of  the  foot-ills  is  corns. 
They  are  best  known  because  most  persons  at  some  time 
have  at  least  one,  and  they  are  one  of  the  least  impor- 
tant ills  because  in  most  instances  they  cause  not  even 
serious  inconvenience,  and  they  usually  disappear  with 
the  use  of  properly  fitting  shoes  and  ordinarily  good 
care  of  the  feet. 

If  numerous  and  painful,  however,  or  if  soft  corns, 
situated  between  the  toes,  they  may  justify  rejection. 

Sweating  feet,  which  soften,  blister,  redden,  and  burn, 
may  cause  rejection,  as  they  are  not  apt  to  stand  much 
marching. 

Stinking  feet  may  justify  rejection  in  most  instances, 
as  constituting  a  nuisance  in  barracks. 

Bunion,  an  inflammatory  and  deforming  joint-afFec- 
tion,  usually  at  the  base  of  the  great  toe,  will,  if  very 
marked,  disqualify. 

Hammer-toe,  a  condition  in  which  a  toe  is  flexed  and 
the  end  presses  on  the  floor,  while  a  knuckle  projects 
above,  is  very  apt  to  cause  lameness  and  may  justify 
rejection. 


THE  RECRUIT  15 

Overlapping  toes  may  disqualify  in  a  somewhat  simi- 
lar manner. 

Deformities  of  the  arch  of  the  foot  are  very  impor- 
tant. It  may  be  too  high,  so  that  the  weight  is  borne  on 
the  ball  of  the  foot  and  the  heel,  the  intermediate  parts 
remaining  clear  of  the  ground.  This  is  a  relatively  rare 
condition,  but  may  disqualify.  A  common  condition  is 
the  opposite,  ox  flat  foot  ^  wherein  the  whole  length  and 
breadth  of  the  foot  touches  the  ground  and  the  arch  is 
almost  or  entirely  obliterated.  Such  a  foot  in  a  white 
man  is  usually  a  poor  marching  foot,  and,  unless  the 
applicant  is  a  desirable  man  and  states  that  he  is  a  good 
walker,  and  that  the  foot  never  gives  him  trouble,  it 
should  cause  rejection.  When  passed,  its  existence 
should  always  be  noted,  in  case  the  man  should  be  dis- 
charged for  it  later.  The  condition  is  more  common  but 
less  important  in  negroes,  but  it  may  cause  trouble  in 
them  also,  particularly  in  the  course  of  long  marches. 

Another  type  of  weak  foot  is  not  really  flattened  but 
tends  to  rotate  outward,  thus  bringing  the  inner  margin 
of  the  foot  nearer  to  the  ground  and  more  directly 
under  the  weight  of  the  body,  where  a  greater  weight 
comes  upon  it,  causing  it  to  tire  and  eventually  to  break 
down  and  become  flat.  It  may  justify  rejection. 

The  genitals  should  be  well-formed  and  normal. 
Both  testicles  should  be  present  and  in  the  scrotum ; 
it  should  be  possible  for  the  applicant  to  ^^ 
retract  his  foreskin,  and  the  penis  should 
not  show  gross  deformities,  such  as  the  opening  of  the 
urethra  being  placed  far  back  from  the  end.  Scars  on 
the  penis  should  prompt  investigation  as  to  their  na- 
ture, whether  syphilitic,  chancroidal,  or  otherwise.  The 
man  should  be  required  to  express  the  contents,  if  any. 


16    THE  RECRUIT  AND  HIS  ENVIRONMENT 

from  the  urethra.  Pus  should  at  once  cause  rejection, 
as  should  any  ulcers  or  sores  on  the  penis,  redness, 
puffiness,  or  signs  of  marked  irritation  about  the 
urethra,  or  the  presence  of  vermin,  commonly  known  as 
crab-lice.  Inflammation  of  the  glans  beneath  the  fore- 
skin, and  venereal  warts,  while  not  in  themselves  dis- 
abling, will  often  justify  rejection  as  capable  of  exciting 
suppurative  buboes,  and  as  resulting  from  venereal 
disease  or  uncleanliness,  or  both. 

Buboes  are  swollen  and  inflamed  lymphatic  glands, 
and  are  found  in  the  groin.  They  may  be  single  or 
multiple,  on  one  or  both  sides,  and  may  vary  in  size 
from  that  of  a  small  cherry  to  that  of  an  orange. 
While  not  all  groin  buboes  are  venereal,  the  great  ma- 
jority of  them  in  applicants  for  enlistment  are,  and 
they  justify  rejection,  even  though  the  applicant  insists, 
as  he  probably  will  if  his  venereal  disease  is  not  plainly 
evident,  that  they  are  due  to  "  strain." 

Varicocele  is  a  condition  of  enlargement  of  the  veins 
of  the  scrotum.  It  is  most  often  found,  and  is  apt  to  be 
most  marked,  on  the  left  side.  The  condition  frequently 
causes  no  symptoms,  though  it  is  often  said  to  cause 
pain,  and  is  apt  to  be  pleaded  as  an  excuse  from  arduous 
duty.  If  present,  it  need  not  cause  rejection  unless  very 
marked  or  unless  the  applicant  says  that  it  produces 
symptoms,  but  when  passed  it  should  always  be  noted, 
and  the  applicant  be  made  to  agree  to  be  operated  upon 
if  symptoms  begin,  or  if  the  condition  comes  to  interfere 
at  all  with  his  duties. 

Hydrocele  is  an  enlargement  of  the  scrotum,  usually 
on  one  side,  caused  by  an  outpouring  of  clear  fluid  into 
the  membranous  sac  surrounding  the  testicle.  It  pro- 
duces a  tense,  painless,  and  often  translucent  swelling, 


THE  RECRUIT  17 

which  may  at  times  be  hard  to  distinguish  from  a  tumor 
of  tlie  testicle  or  a  hernia.  Any  one  of  the  conditions, 
however,  may  suffice  to  exclude  the  applicant  in  time  of 
peace. 

While  not  much  reliance  can  be  placed  on  an  applio 
cant's  denial  of  venereal  disease  and  his  assertions  as  to 
perfect  genital  health,  he  should  be  questioned  on  the 
subject,  and  should  be  asked  as  to  the  frequency  of 
urination  and  his  ability  to  pass  a  good  stream  of  urine. 
Dribbling  or  inability  to  pass  a  good  stream,  or  to  hold 
or  control  his  urine,  should  cause  rejection. 

The  skin  will  necessarily  be  noticed  and  examined 
during  the  examination  previously  described.  One  of 
the  first  and  most  important  points  to  be  «,  . 
noted  is  its  cleanliness.  A  dirty,  foul,  stink- 
ing skin  usually  indicates  the  type  of  man  not  wanted  in 
our  army,  and  it  justifies  rejection  without  further  exam- 
ination. Certain  men,  however,  appear  with  their  skins 
soiled  with  sweat  and  dust  simply  because  of  lack  of 
opportunities  for  cleanliness,  and  if  their  general  appear- 
ance and  their  stories  indicate  that  they  are  desirable 
men,  they  should  be  given  an  opportunity  to  bathe  and 
then  be  examined.  It  must  not  be  forgotten  that  a 
filthy  man  may  bathe  for  examination,  but  reveal  his 
usual  habits  by  his  linen.  However  revealed,  filthy 
habits  should  cause  rejection. 

A  skin  showing  the  marks  of  severe  and  generalized 
scratching  is  usually  indicative  of  disease  or  vermin 
infestation,  and  is  therefore  objectionable. 

All  forms  of  contagious  skin  diseases,  such  as  ring- 
worms and  syphilitic  eruptions,  should  cause  rejec- 
tion, or,  in  the  person  of  an  enlisted  man,  call  for 
prompt  treatment.  As  the  line  officer  cannot  be  ex' 


18    THE  RECRUIT  AND  HIS  ENVIRONMENT 

pected  to  differentiate  such  affections,  he  will  be  on  the 
safe  side  if  he  treats  them  all  as  suspicious,  though  he 
should  if  possible  learn  to  recognize  acne,  the  common 
"  pimply"  eruption  seen  on  the  chests,  backs,  and  faces 
of  many  young  men.  It  is  usually  not  a  severe  affec- 
tion, and  as  it  may  coexist  with  good  health  and  good 
habits,  it  should  not  cause  rejection. 

While  a  few  men  who  are  not  really  physically  fit 
get  into  the  service,  there  are  a  good  many  more  who 
-,,  are    morally  or  mentally  unfit,   and  they 

are  the  men  who  later  spend  much  of  their 
time  in  the  guard-house  or  who  swell  the 
number  of  desertions.  Against  this  class  of  men  the 
recruiting  officer  works  at  a  disadvantage.  Unfortu- 
nately, almost  any  man,  no  matter  what  his  character, 
can  get  letters  of  recommendation,  so  that  such  letters 
are  really  of  little  importance,  and  the  officer  is  forced 
to  rely  largely  on  his  own  ability  to  judge  men  by  ap- 
pearances, —  a  notoriously  unsafe  thing,  and  an  almost 
impossible  thing  for  some  individuals.  Some  aid  is  ob- 
tained, though,  by  attention  to  the  applicant's  general 
bearing,  his  facial  expression,  his  quickness  of  appre- 
hension, the  condition  of  his  person  and  his  clothing, 
and  such  evidences  of  alcoholism,  venereal  disease,  good 
habits,  and  truthfulness  as  the  examination  may  bring 
out.  When  a  man  declares  that  he  never  drinks,  although 
his  breath  is  strong  with  alcohol  at  the  time,  or  that  he 
has  never  had  venereal  disease,  though  he  shows  a  scar 
on  his  penis  and  another  in  his  groin,  or  has  a  suppura- 
tive bubo  that  he  says  is  due  to  a  strain,  the  inference 
is  fair  that  he  is  a  liar  and  undesirable. 

Under  our  system  of  voluntary  enlistment,  and  as 
long  as  there  are  plenty  of  applicants,  it  is  better  to 


THE  RECRUIT  19 

reject  all  those  about  whom  the  officer  cannot  feel  well 
satisfied  ;  and  this  whole  chapter  is  based  on  such  an 
assumed  condition  of  affairs.  In  time  of  war,  or  when 
the  supply  of  applicants  for  enlistment  is  not  up  to  the 
demands,  many  men  can  be  passed  who  would  be  ex- 
cluded under  our  assumed  conditions ;  but  in  all  such 
cases  they  should  only  be  passed  by  medical  officers  ex- 
ercising great  care,  and  every  defect  should  be  noted, 
both  as  to  its  presence  and  its  degree,  as  constituting  a 
possible  ground  of  application  for  a  pension. 

The  man  being  in  the  service  and  any  defect  coming 
to  his  commanding  officer's  attention,  he  should  be  re- 
ferred to  a  medical  officer  to  have  it  corrected  if  prac- 
ticable, but  at  any  rate  to  have  it  noted,  in  the  interests 
of  justice  to  the  man  and  to  the  government,  and,  if 
it  be  sufficiently  serious,  to  have  the  man  discharged 
before  he  breaks  down  in  time  of  stress,  with  possibly 
serious  results. 

In  this  as  in  nearly  all  respects,  the  medical  officer's 
duties  can  be  performed  more  promptly  and  effectively 
if  he  has  the  cooperation  of  the  line  officer. 

Official  guidance  in  the  examination  of  recruits  is 
found  in  General  Order  66,  W.D.,  April  18, 1910,  and 
in  regulations  and  orders  issued  from  time  to  time. 


CHAPTER  II 

PERSONAL  HYGIENE 

The  recruit  having  been  accepted  for  the  service  in 
good  health  and  good  physical  condition,  it  is  his  duty 
to  himself  and  to  his  government  to  maintain  those 
desirable  conditions  unchanged  except  for  the  better, 
if  it  be  possible  for  him  to  do  so.  It  will  be  possible  in 
large  part,  if  he  is  taught  how  to  do  it,  and  it  is  there- 
fore incumbent  upon  his  officers  to  teach  him  at  least 
the  rudiments  of  personal  hygiene,  and  those  rudiments 
may  be  summarized  as  follows :  — 

First  of  all  he  must  be  taught  the  importance  of  au 
abundance   of   fresh  air   both   day   and   night,   as   a 
health-giving,  strength-producing,  and  life- 
prolonging  measure.    He  must  know  that 
"  colds,"  sore-throat,  pneumonia,  and  kindred  troubles 
are  not  caused  by  cold  air,  but  by  micro-organisms; 
that  those  micro-organisms  are  much  more  numerous 
and  mucl^more  apt  to  harm  him  in  a  warm,  "  close  " 
room,  with  impure  and  rebreathed  air,  than  in  the  open ; 
and  that  such  diseases  are  more  common  in  cold  weather, 
))aitly  because  in  trying  to  exclude  the  cold,  man  is  apt 
to  include  such  air.    The  habit  of  breathing  deeply  and 
thoroughly  changing  the  air  in  the  lungs  is  imparted  to 
him  by  his  gymnastic  and  military  drills,  and  is  helpful. 
He  should  also  learn  early  that  his  rest  is  important 
and  should  be  taken  regularly,  in  order  to 
preserve  his  health  and  enable  him,  for  that 
reason,  to  do  without  it  more  easily  when  the  neces- 


PERSONAL  HYGIENE  21 

sity  arises.  He  should  get  eight  hours  of  sleep  in  each 
twenty-four,  while  four  hours  more  should  be  allowed 
for  meals  and  short  rests,  changing  of  clothing,  etc.  In 
the  remaining  twelve  hours  he  should  do  his  work  and 
his  play.  Regularity  in  rest  and  work  is  of  great  im- 
portance, and  that  is  probably  one  reason  that  so  many 
men  improve  rapidly  in  physique  after  entering  military 
service.  On  the  other  hand,  it  is  debilitating  and  de- 
moralizing to  steal  the  hours  from  sleep  for  drinking 
and  venery.  It  is  desirable  that  the  night's  rest  be  taken 
in  clothing  different  from  that  used  in  the  daytime,  and 
the  latter  should  be  allowed  to  air.  Every  man  should 
possess  and  use  night-clothing,  and  the  not  uncom- 
mon habit  of  sleeping  in  the  underclothing  should  be 
discouraged.  No  man  should  have  a  "  barrack  odor  " 
clinging  to  him,  and,  if  ventilation  and  clothing  are 
looked  after,  he  will  not. 

The  most  beneficial  exercise  is  that  obtained  incident- 
ally to  work  or  recreation.  Exercise  taken  purely  as 
such  is  usually  repugnant,  and  takes  on  the  .^ 
aspect  of  work  to  men  who  feel  that  they 
already  have  an  abundance  of  it.  It  should  therefore  be 
taken  with  some  other  incentive  than  is  furnished  by 
official  orders.  Baseball  games,  field  sports,  and  other 
athletic  competitions  should  be  encouraged,  and  the 
effort  should  be  made  to  interest  and  include  all  the  men 
in  them,  and  not  merely  a  baseball  nine  and  a  few  ex- 
pert athletes  in  each  post.  The  objects  to  be  attained  by 
exercise  are  the  increase  of  the  strength  of  the  heart 
and  the  capacity  of  the  lungs  (on  which  two  depend  en- 
durance, the  increase  of  muscular  strength,  of  nervous 
stability  and  control,  of  digestion  and  assimilation),  and 
keeping  the  emunctories  (the  channels  of  waste  excre- 


22    THE  RECRUIT  AND  HIS  ENVIRONMENT 

tion,  such  as  the  skin,  kidneys,  and  bowels)  active. 
No  form  of  exercise  at  present  encouraged  in  the  army 
fails  to  promote  some  of  these  ends,  so  they  are  all 
good. 

Cleanliness  of  person,  clothing,  and  bedding  should, 
and  usually  does,  become  a  habit  of  life  with  the  soldier ; 
_.  ..  but  some  men  require  much  watching  and 
admonition  to  make  it  become  so,  and  fre- 
quent inspections  should  be  made  in  order 
that  the  admonition  may  not  be  wanting.  In  general,  it 
may  be  stated  that  dirty  soldiers  are  either  recruits  or 
men  who  through  drink  or  vicious  habits  have  suffered 
in  their  self-respect.  Body  lice  are  rarely  seen  in  our 
service  except  in  guard-houses,  where  they  may  be  in- 
troduced by  captured  deserters  or  other  prisoners.  Bed- 
bugs are  occasionally  found,  and  head-lice  and  itch 
infrequently.  All  of  these  pests  should  be  carefully 
watched  for  and  exterminated  when  found,  as  not  only 
are  they  disgusting  in  themselves,  and  indicative  of 
careless  or  filthy  habits,  but  it  seems  quite  possible 
that  they  may  act  at  times  as  carriers  of  disease.  Bed- 
bugs, when  once  introduced  in  barracks,  are  at  times 
very  hard  to  dislodge,  particularly  if  the  buildings  are 
old  and  show  many  cracks  in  the  walls. 

Personal  cleanliness  should  be  understood  as  includ- 
ing the  exclusive  use  of  one's  own  linen  and  toilet 
articles.  Disease  may  be  transmitted  readily  by  the 
indiscriminate  or  common  use  by  several  persons  of  the 
same  towels,  sponges,  wash-cloths,  combs,  hair-brushes, 
shaving-brushes,  etc.  Some  of  the  diseases  which  are 
most  readily  transmitted  by  these  means  are  itch,  ring- 
worms and  other  skin  diseases,  granulated  eyelids, 
gonorrheal  infection  of  the  eyes,  body  vermin,  and, 


PERSONAL  HYGIENE  23 

occasionally,  such  infectious  diseases  as  typhoid  fever 
or  smallpox. 

It  is  not  necessary  that  a  man  should  bathe  his  body 
daily  unless  he  is  engaged  in  particularly  arduous  or 
dirty  work,  but  he  should  bathe  at  least  twice  a  week 
in  summer  and  once  a  week  in  winter,  and  as  much 
of tener  as  is  necessary  to  keep  his  skin  clean  and  free 
from  all  odor,  especially  from  the  feet,  crotch,  genitals, 
and  armpits,  and  particular  attention  should  be  given 
to  those  parts.  Once  or  twice  a  week,  or  oftener  if 
necessary,  the  washable  clothing,  —  shirts,  drawers, 
and  socks, —  should  be  changed,  and  fresh  put  on. 
More  frequent  baths  and  changes  do  no  harm,  but 
should  not  ordinarily  be  demanded,  except  in  the  tropics. 

The  soldier  cannot  well  give  too  much  attention  to 
his  feet^  as  he  thereby  keeps  them  in  good  condition 
and  directly  increases  his  value  as  a  soldier.  Any  trou- 
ble with  them  should  at  once  be  corrected  by  the  man, 
by  means  of  bathing,  clean  socks,  properly  fitting  shoes, 
proper  nail-trimming  and  cleaning;  or,  if  of  a  kind  not 
corrected  by  such  means,  it  should  be  reported  to  the 
surgeon. 

The  hands  are  not  subject  to  so  many  disabilities  as 
the  feet,  but  they  should  be  kept  clean  and  sound,  the 
nails  clean  and  trimmed,  and  it  should  become  a  matter 
of  routine  to  wash  them  before  taking  food,  as  diseases 
so  diverse  as  lead-poisoning  and  typhoid  fever  may 
result  from  the  neglect  of  such  a  practice. 

The  scalp  should  not  be  neglected  in  the  general 
cleaning,  and  its  cleansing  is  facilitated  by  having  the 
hair  short. 

Bedding  should  be  aired  and  bed  linen  changed 
weekly. 


24    THE  RECRUIT  AND   HIS  ENVIRONMENT 

The  clothing  issued  by  the  government  is  nearly 
always  of  good  quality,  and  is  furnished  in  sufficient 
_.     ,  ,  quantity  to  enable  the  soldier  to  be  always 

°  comfortably,  seasonably,  neatly,  and  cleanly 
attired  in  a  uniform  and  soldierly  manner,  and  as  much 
should  always  be  demanded  of  him.  He  has  to  pay  for 
his  laundry-work,  and  he  should  have  enough  done  to 
meet  all  the  requirements  indicated  above. 

The  individual  soldier  has  relatively  little  to  do  with 
the  choice  of  his  food,  and  the  subject  will  be  dealt 
_     .  with  at  greater  length  in  a  later  chapter. 

°  He  has  all  to  say,  however,  as  to  how  he 
shall  eat  what  is  served  to  him,  and  he  should  be  taught 
to  avoid  gluttony,  to  eat  with  an  observance  of  the 
decencies,  to  chew  his  food  thoroughly  and  eat  slowly, 
to  be  as  regular  in  his  hours  and  habits  of  eating  as 
his  duties  permit,  and  to  avoid  the  use  at  meals  of  the 
enormous  quantities  of  liquid,  particularly  coffee,  in 
which  he  seems  to  find  delight.  A  ])int  of  water  may  be 
taken  with  a  meal  without  harm,  but  a  pint  of  coffee  is 
apt  to  cause  some  disturbance,  while  a  quart  is  much 
more  apt  to  do  so ;  and  the  fact  that  so  little  demon- 
strable harm  does  result  is  probably  due  to  the  good 
general  physique  and  surroundings  of  the  soldier.  Many 
soldiers,  especially  young  ones,  are  prone  to  indulge  at 
almost  every  opportunity  in  the  eating  of  fruits  and 
pastries,  with  less  regard  to  the  quality  than  to  the 
quantity.  This  tendency  is  lessened  by  a  good  company 
mess,  and  it  should  be  discouraged  as  apt  to  lead  to 
digestive  disturbances. 

Regularity  of  the  bowels  should,  if  practicable,  be 
established  and  maintained  by  regular  habits,  good 
food,  the  use  of  fruits  and  bulky  foods,  such  as  vege> 


PERSONAL  HYGIENE  26 

tables  and  oatmeal,  and  by  exercise.  Irritating  or 
highly-seasoned  foods  should  be  used  sparingly,  if  at 
all. 

Among  people  of  education  and  refinement  cleanli- 
ness of  the  mouth  is  of  course  as  much  of  a  routine  as 
cleanliness  of  face  and  hands,  but  persons 
whose  education  and  rearing  have  been  less 
carefully  supervised  are  apt  to  neglect  it, 
and  recruits  and  occasionally  soldiers  from  the  latter 
class  are  at  times  seen  with  their  mouths  in  a  shameful 
state  as  the  result  of  such  neglect. 

They  should  be  taught  (a)  that  such  ailments  as 
indigestion,  toxic  absorption,  toothache,  sore  throat 
and  sore  mouth  may  result  directly  from  such  neglect, 
while  many  serious  diseases  are  much  aggravated  by  it, 
and  (b)  what  will  probably  be  more  effective,  that  its 
existence  is  a  mark  of  poor  rearing  and  inferiority. 

Every  company  commander  should  instruct  his  men 
somewhat  as  follows :  — 

1st.  Every  man  should  have  a  tooth-brush,  and 
should  so  use  it  at  least  twice  daily,  and  preferably 
oftener,  as  to  remove  from  the  teeth  and  gums  all  par- 
ticles of  food  or  other  foreign  matter,  brushing  away 
from  the  gums  and  in  all  cracks  and  crevices. 

2d.  That  he  should  after  each  meal  remove  from 
between  the  teeth,  with  a  wooden  or  quill  tooth-pick, 
or  with  a  thread,  any  pieces  of  meat  or  other  food,  and 
not  allow  it  to  remain  and  putrefy. 

3d.  That  he  should  promptly  consult  a  dentist  or  a 
medical  officer  about  any  trouble  arising  in  the  teeth 
or  gums.  The  medical  officer  can  at  least  give  him 
proper  advice,  and  in  many  instances  proper  treat- 
ment. 


.26    THE   RECRUIT  AND  HIS   ENVIRONMENT 

Much  harm  is  done  by  careless  spitting,  urination, 
and  defecation  in  improper  places,  by  men  ignorant  of 
_  the  harm  they  may  thus  do.  Because  appar- 

_  .  ently  healthy  themselves,  it  does  not  occur 
r  fl  Of  ^  them  that  they  may,  in  answering  a  per- 
,  fectly  natural  call,  transmit  disease  to  oth- 

ers. Yet,  as  will  be  shown  in  other  places, 
they  may  be  giving  off  the  organisms  causing  typhoid 
or  other  infections  in  their  urine  or  feces,  or  those 
causing  diphtheria,  tuberculosis,  or  other  disease  in 
their  spit,  and  such  organisms  may  then  soak  or  wash 
into  the  water-supply,  or  may  be  carried  as  dust  or 
mud  to  the  mouths,  hands,  food,  or  breath  of  healthy 
persons,  and  so  infect  them.  Decency  and  patriotism 
should  prompt  a  man  to  show  as  much  regard  for  the 
health  of  his  comrades  as  for  his  own. 

The  question  of  venereal  disease  will  be  dealt  with 
in  a  subsequent  chapter.     Much  of  it  could  be  avoided 
if  the  ignorance  and  misconception  regard- 
_  .,  ing  sexual  life  could  be  dissipated.    Every 

man  should  know  that  sexual  continence 
is  compatible  with  perfect  physical  health,  while  its 
maintenance  is  far  greater  evidence  of  character  and 
"  manliness  "  than  is  the  association  with  prostitutes, 
the  abasement  of  virtuous  girls,  or  the  lowering,  self- 
respect-destroying  and  demoralizing  practice  of  mastur- 
bation. The  sexual  organs  and  sexual  desire  are  placed 
in  man  that  he  may  procreate  and  replenish  the  race ; 
but  there  is  no  physical  penalty  for  his  failure  to  do 
so,  and  the  sperm  necessary  for  the  purpose  will  be  dis- 
charged in  sleep  when  it  has  accumulated  sufficiently. 
"  Wet  dreams  "  and  involuntary  seminal  emissions  are 
not,  therefore,  necessary  evidences  of  "loss  of  man- 


PERSONAL  HYGIENE  27 

hood  "  or  of  any  other  disorder,  but  are  seen  to  be  the 
natural  and  healthy  method  of  disposal  of  the  sperm 
not  used  in  the  legitimate  sexual  intercourse  of  married 
life.  Every  normal  man  has  periods  of  sexual  excite- 
ment and  desire,  which  constitute  one  of  Nature's  pow- 
erful influences  in  the  perpetuation  of  the  race;  but 
self-respect  should  prompt  and  self-command  enforce  a 
determination  that  such  desire  shall  not  lead  to  acts 
that  violate  the  laws  of  religion  and  society.  These 
periods  of  excitement  and  desire  can  be  made  less  fre- 
quent, and  continence  promoted,  by  the  avoidance  of 
fasciviousness  in  speech,  conduct,  reading,  and  thoughts, 
by  thorough  cleanliness  and  otherwise  complete  neglect 
of  the  genitals,  and  by  a  regular,  sober,  active  life. 

The  habitual  and  excessive  use  of  alcohol  is  every- 
where conceded  to  be  harmful,  while  the  moderate  or 
judicious  use  of  it  excites  much  discussion,  .  .  ,  ^ 
but  is,  in  this  country  at  least,  falling  into 
disfavor.  Owing  partly  to  the  prohibition  of  the  sale 
of  wines  and  beer  on  government  reservations,  the  con- 
ditions under  which  a  soldier  now  indulges  in  alcohol 
are  in  most  instances  not  conducive  to  "  moderate  "  or 
judicious  use  of  it ;  so  that,  laying  aside  all  theory, 
and  dealing  only  with  the  condition  confronting  us,  it 
is  our  duty  to  advise  and  encourage  total  abstinence  in 
the  soldier.  This  we  may  be  able  to  obtain  in  certain 
instances,  but  it  does  not  seem  probable  that  it  will  be 
a  universal  characteristic  of  soldiers  during  the  active 
service  of  the  readers  of  this  paragraph.  We  should, 
however,  particularly  try  to  inculcate  it  in  the  young 
recruit,  as  the  man  who  does  not  begin  to  drink  before 
he  is  twenty-five  years  of  age  is  much  less  apt  to  become 
a  drunkard  or  a  habitual  user  than  he  who  begins  before 


28    THE   RECRUIT  AND  HIS  ENVIRONMENT 

he  is  twenty,  and  there  is  a  good  chance  that,  if  he 
abstains  nutil  that  age,  he  will  always  do  so.  On  the 
other  hand,  the  impossibility  of  knowing  who  are,  and 
who  are  not,  capable  of  using  alcohol  judiciously  should 
prevent  our  encouraging  what  we  regard  as  judicious 
use  in  soldiers.  Every  military  post  shows  in  its  guard 
reports,  its  sick  reports,  and  in  unrecorded  ways,  the 
injury  and  loss  of  service  resulting  from  excessive  use 
of  alcohol  ;  so  that  it  is  not  necessary  either  to  quote 
military  statistics  or  to  go  to  civil  life  for  the  lesson. 
However,  the  very  nature  of  a  soldier's  calling  so  re- 
stricts his  freedom  of  action,  so  excludes  him  from  many 
refining  and  restraining  influences,  and  so  throws  him 
in  the  way  of  temptation  to  drink,  that  we  should  highly 
honor  him  in  the  mass  for  his  good  conduct,  and  encour- 
age him  in  it  as  an  individual. 

If  used  at  all,  alcohol  is  preferably  and  least  harm- 
fully taken  with  or  after  meals. 

It  will  do  little  good  to  warn  men  against  the  use  of 
strong  alcohol,  of  flavoring  extracts,  bay  rum,  and  wood 
alcohol,  as  only  abandoned  drinkers  use  such  prepara- 
tions as  beverages,  and  such  men  are  not  apt  to  heed  the 
warning.  However,  it  is  important  to  know  that  wood 
alcohol  and  its  preparations  are  more  poisonous  than 
ordinary  alcohol,  and  that  death,  or  complete  and  per- 
manent blindness,  may  follow  their  use. 

Probably  the  least  harmful  and  the  most  general  of 
the  so-called  "  bad  habits  "  is  the  use  of  tobacco  in  one 
form  or  another.  In  our  army  the  methods 
of  using  it  are  smoking  and  chewing.  Of 
these  chewing  is  probably  the  most  objectionable  as 
fouliniT  the  mouth  and  causing  promiscuous  spitting. 
Moderate  smoking,  indulged  in  after  meals  and   in 


PERSONAL  HYGIENE  29 

periods  of  relaxation,  cannot  be  said  to  be  very  harm- 
ful, if  at  all  so ;  but  smoking  in  excess  may  do  harm  by 
causing  digestive,  respiratory,  and  nervous  disturbances, 
among  which  may  be  heartburn,  headache,  palpitation 
or  irregularity  of  the  heart,  insomnia,  tremor,  cough, 
and  hoarseness.  Just  what  constitutes  excess  may  not 
be  stated,  as  an  amount  harmless  to  one  man  may  be 
enough  to  cause  injury  to  another.  In  general  terms  we 
may  say  that  an  amount  causing  any  of  the  above-named 
or  other  symptoms  in  any  man  constitutes  an  excess  for 
that  man.  As  to  the  various  methods  of  smoking,  the 
same  general  principles  apply.  Cigar,  pipe,  and  cigar- 
ette are  equally  harmless  if  not  used  to  excess.  The  main 
objection  to  cigar-smoking  is  the  expense ;  to  pipe- 
smoking,  the  irritation  of  the  mouth,  in  rare  instances 
eventuating  in  cancer ;  and  to  cigarette-smoking,  the 
habit  of  inhaling  the  smoke  and  thus  exposing  a  much 
greater  surface  to  the  fumes,  causing  irritation  of  the 
vocal  organs  and  the  bronchial  tubes,  and  the  habit  of 
rolling  and  smoking  a  cigarette  at  each  opportunity,  so 
that  the  total  number  consumed  becomes  excessive.  The 
habit  of  smoking  and  the  proper  indulgence  of  the  habit 
do  the  soldier  so  little  harm  and  so  greatly  increase  his 
comfort  and  contentment  that  they  should  not  be  inter- 
fered with.  Stale  tobacco-smoke  in  quarters,  however, 
gives  a  very  unpleasant  odor,  and  the  room  should  be 
daily  opened  and  aired  sufficiently  to  prevent  or  dissi- 
pate this. 

There  should  be  no  necessity  for  telling  men  to  dress 
properly  for  the  season  and  the  climate,  but  the  neces- 
sity nevertheless  exists,  owing  to  the  carelessness,  igno- 
rance, or  perversity  of  men.  It  is  neither  profitable  nor 
wise  for  an  officer  to  undertake  to  prescribe  just  what 


30    THE  RECRUIT  AND  HIS  ENVIRONMENT 

his  men  shall  wear  at  all  times,  as  men  differ  in  their 
capacity  to  stand  heat  and  cold,  and  one  man  may  be 
able  to  maintain  the  highest  degree  of  health 
*^    '  and  comfort  by  never  wearing  flannel  under- 
clothing,  while  his  neighbor  may  promote 
both  by  wearing  it  the  year  round,  and  the 
rest  of  the  men  in  the  squad-room  by  wear- 
ing flannel  in  winter  and  cotton  in  summer.  But  men 
should  be  taught  that  exposure  to  either  heat  or  cold 
lowers  the  resistance  of  the  body  and  predisposes  it 
to  disease ;  that  body- warmth  is  promoted  by  woolen 
clothing  and  that  linen  and  cotton  make  cool  clothing ; 
that  alcohol  is  not  a  fit  substitute  for  an  overcoat  or  a 
rain-coat ;  that  wet  feet  should  be  dried  and  dry  cover- 
ings substituted  for  wet  ones  after  marching  or  other 
exercise ;  that  good  intentions  or  thoughtlessness  do 
not  justify  reckless  exposure  to  extremes;  and  that  it  is 
their  duty  to  the  government,  as  well  as  to  themselves, 
to  use  discretion  in  dress  and  to  try  at  all  times  to 
avoid  sickness. 

Exposure  to  strong  sunlight  is  by  some  persons  al- 
leged to  be  the  cause  of  some  of  the  evils  heretofore 
credited  to  the  heat  of  the  sun,  and  it  is  further  stated 
that  these  effects  may  be  obviated  by  the  use  of  hat- 
linings  and  underclothing  of  black,  red,  or  orange,  to 
exclude  the  actinic  rays.  However,  rather  extensive 
observations  and  investigations  made  by  various  work- 
ers in  the  Philippines  have  afforded  little  or  no  support 
for  such  assertions. 

In  all  climates  and  at  all  times  the  dress  should  be 
comfortable,  and  should  hamper  the  movements,  espe- 
cially of  the  chest  and  abdomen,  as  little  as  possible. 
The  equipment  should  be  as  light  as  circumstances  will 


PERSONAL  HYGIENE  31 

permit,  should  also  be  arranged  with  the  idea  of  inter- 
fering with  motion,  particularly  of  the  chest  and  ab- 
domen, as  little  as  possible,  but  should  contain  the 
necessary  articles. 

While  the  government  supplies  the  necessities  of  the 
soldier  and  supervises  his  hygiene  to  a  considerable 
extent,  it  is  seen  already  that  the  man  himself  is  re- 
sponsible for  much,  and  there  are  a  few  more  golden 
rules  that  he  should  learn  early  for  his  own  protection, 
and  that  will  bear  frequent  emphasis  and  repetition, 
especially  in  campaign. 

1.  Be  clean  in  person,  clothing,  and  surroundings. 

2.  Eat  no  food  but  good  food,  and  only  with  clean 
bands. 

3.  Drink  no  water  from  unauthorized  or  doubtful 
sources,  unless  it  is  boiled, — plain,  or  in  tea  or  coffee. 

4.  Abhor,  avoid,  and  destroy  vermin,  whether  lice, 
fleas,  ticks,  flies,  mosquitoes,  roaches,  mice,  rats,  or  other 
varieties. 


CHAPTER  III 

FOODS   AND  THEIR  PREPARATION 

It  is  now  trite  and  partly  true  that "  an  army  travels 
on  its  belly,"  and  plainly  evident  that  the  health  and 
happiness  of  the  individual  soldier  depend  very  greatly 
on  what  he  puts  into  his  belly.  This  is  a  matter  largely 
in  the  control  of  the  company  commander,  and  it  is 
therefore  important  that  he  should  have  some  know- 
ledge of  foods  and  their  preparation,  and  should  pay 
great  attention  to  mess-administration.  Many  company 
commanders  do  so,  but  others,  knowing  little  of  the 
subject,  delegate  the  entire  matter  to  their  mess-ser- 
geants, who  may  know  less,  and  the  men  suffer.  The 
government  ration  and  the  regulations  concerning  its 
use  are  very  liberal,  and  if  a  company  does  not  have 
an  abundance  of  good,  nutritious,  and  attractive  food, 
the  fault  is  nearly  always  in  its  handling  after  it  reaches 
the  company. 

Foods  are  of  different  classes,  and  a  judicious  and 
proper  mixture  of  these  is  necessary  for  the     classes 
maintenance  of  health  and  strength. 

Proteids^  or  albuminous  foods,  are  the  class  repre- 
sented by  the  white  of  egg  or  lean  beef.  They  occur  also 
in  vegetables,  beans  and  peas  being  particularly  rich  in 
proteid,  and  this  fact  makes  an  exclusively  vegetarian 
diet  a  health-sustaining  possibility,  which  a  proteid  free 
diet  is  not.  Animal  proteid  is  more  easily  and  com- 
pletely digested  than  that  from  vegetables,  and  to  most 
persons  is  also  more  agreeable.  An  exclusive  meat  diet 


FOODS   AND  THEIR    PREPARATION        33 

can  maintain  health  and  strength  for  long  periods  of 
time,  and  recent  careful  observations  on  the  Eskimos 
of  Disco  Island  in  Western  Greenland  show  that  they 
maintain  excellent  health  and  nutrition  on  a  diet  almost 
exclusively  of  meat.  "  The  physical  endurance  of  Es- 
kimos nourished  in  this  way  is  conspicuous,  as  is  tlieir 
resistance  to  the  rigors  of  the  climate." 

Fats  are  the  class  of  food  represented  by  the  fatty 
tissues  of  animal  bodies  and  the  various  vegetable  oils. 
They  are  very  valuable  as  foods,  owing  to  their  great 
fuel- value  and  the  amount  of  nutriment  contained  in  a 
small  bulk ;  but  if  taken  in  excess  they  are  difficult  of 
digestion  and  cause  dyspepsia  and  diarrhoea.  They  are 
especially  valuable  in  cold  climates,  a  fact  which  we 
recognize  in  our  practice  of  eating  pork  and  other  fat 
foods  more  freely  in  winter. 

Carbohydrates  are  the  sugars  and  starches,  repre- 
sented by  cane-sugar,  fruit-sugar,  and  others,  and  by 
starchy  vegetables  such  as  potatoes  and  grains.  For 
practical  purposes  we  may  say  that  the  carbohydrates 
are  of  vegetable  origin.  Cellulose,  as  found  in  the  husk 
and  fibre  of  plants,  is  another  form  of  carbohydrate, 
having  a  food-value  for  herbivorous  animals  but  none 
for  man.  The  carbohydrates  have  about  the  same 
fuel- value,  weight  for  weight,  as  the  proteids,  and  less 
than  that  of  the  fats.  Starches  may  be  taken  in  large 
amounts,  but  sugar,  if  taken  in  excess  or  in  too  con- 
centrated a  form,  causes  dyspepsia  and  other  disorders. 

Inorganic  salts,  as  represented  by  common  salt  and 
other  salts  contained  in  foods,  have  no  fuel-value,  but 
are  necessary  in  maintaining  the  nutrition  of  the  body, 
and  the  same  is  true  in  even  greater  degree  of  water. 

Organic  acids,  flavors^  and  condiments,  as  found  in 


34    THE  RECRUIT  AND  HIS  ENVIRONMENT 

fruits,  many  vegetables,  and  in  spices,  are  of  value 
secondary  to  the  preceding  classes. 

There  is  another  class  of  substances  that  are  not 
carbohydrate,  proteid,  nor  fat,  that  occur  in  very  minute 
quantities  in  foods,  the  existence  of  which  has  been  known 
for  only  a  short  time,  yet  they  are  very  important  and 
their  absence  from  the  diet  results  in  disease  or  death. 
These  substances  are  spoken  of  as  vitamines,  and,  while 
they  are  probably  numerous,  each  appears  to  have  a  spe- 
cific value,  in  that  its  absence  causes  a  specific  disease. 
Among  diseases  caused  by  lack  of  vitamines  are  beri- 
beri and  scurvy,  rickets  probably  and  pellagra  possibly. 

The  vitamine  that  prevents  beri-beri  is  found  in  very 
small  amounts  in  meat  and  vegetables,  in  larger  amounts 
in  peas  and  beans.  It  occurs  in  rice  but  is  there  found 
only  near  the  surface  of  the  grain,  in  or  closely  adjacent 
to  the  pericarp  or  brownish  colored  outside  of  the  grain. 
When  the  rice  is  highly  milled  and  made  white  the  outer 
layer  of  the  grain  with  its  contained  vitamine  is  removed. 
Hence  persons  living  principally  on  highly  milled  rice 
are  subject  to  beri-beri,  while  others  living  on  unmilled, 
hand  milled,  or  undermilled  rice  do  not  have  it. 

Following  the  substitution  of  undermilled  for  highly 
milled  rice  and  the  addition  to  the  dietary  of  "  mongo  " 
beans,  beri-beri  promptly  disappeared  from  the  Philip- 
pine Scouts,  from  Bilibid  prison,  Culion  leper  colony, 
and  other  places  in  the  Philippines,  and  elsewhere. 

Scurvy  is  caused  by  the  lack  of  a  vitamine  that  ex- 
ists in  fresh  meats,  fresh  fruits  and  green  vegetables, 
but  not  in  cured  meats,  in  grains,  dried  fruits  or  beans, 
hence  the  former  great  prevalence  of  the  disease  at  sea 
on  long  voyages,  and  in  war,  especially  in  besieged  places. 
Guinea  pigs  can  be  given  scurvy  by  feeding  them  for 


FOODS  AND  THEIR  PREPARATION         35 

about  a  month  on  bread  and  dried  mongo  beans.  On 
the  other  band  a  diet  of  bread  and  sprouted  mongo 
beans  protects  and  maintains  them  in  good  health. 

Infants  nursed  at  the  breast  or  fed  on  raw  milk  do 
not  have  infantile  scurvy.  Fed  on  boiled  or  canned 
milk  they  are  liable  to  it  unless  also  given  orange  juice, 
meat  juice,  or  other  antiscorbutics. 

For  many  years  Voit's  standard  was  taken  as  repre- 
senting the  approximate  amounts  of  the  three  main 
classes  of  foods  necessary  each  twenty-four 
hours  for  the  maintenance  of  health  and 
vigor  in  the  average  working  adult. 

According  to  that  standard  the  requirement  was  118 
grams  of  dried  proteid,  equaling  about  one  ration  of 
beef,  56  grams  of  fat,  and  500  grams  of  carbohydrate, 
that  is,  of  starch  and  sugar.  The  total  value  of  this  diet 
was  over  3000  calories. 

More  recently,  Professor  Chittenden  of  Yale  Uni- 
versity has  shown  that  health,  strength,  and  vigor  can 
be  maintained  by  many  individuals  on  half  the  amount 
of  proteid,  without  any  increase  in  the  fats  or  carbo- 
hydrates. 

Meats  are  mixtures  of  proteids  and  fats,  and  contain 
water  and  salts  also.    They  vary  in   palatability,  cost, 
digestibility,  and  nutritive  value ;  but  all     •Mp'afa 
meats  have  nutritive  value,  though  if  dis- 
eased or  decomposed  they  are  not  available  for  use. 

In  our  service  beef  is  the  standard  meat  for  issue, 
mutton,  pork,  fowl,  and  fish  being  substitutes  issued 
only  occasionally ;  and,  considering  the  cost,  nutritive 
value,  palatability,  digestibility,  tolerance,  etc.,  it  is 
the  most  valuable  meat. 

Mutton  is  almost  equally  valuable  for  nutrition,  but 


36    THE  RECRUIT  AND   HIS  ENVIRONMENT 

many  persons  dislike  the  taste  of  it,  and  almost  all  tire 
of  it  sooner  than  of  beef. 

Pork  is  fatter  than  either  beef  or  mutton,  and  is 
therefore  much  more  used  in  cold  than  in  warm  weather. 
It  is  more  difficult  of  digestion  than  beef  and  not  so 
generally  liked,  though  bacon  is  much  used  in  the  army 
and  is  a  popular  and  valuable  food,  especially  in  the 
field. 

Veal  is  seldom  issued  to  troops.  Its  nutritive  value 
is  somewhat  less  than  that  of  beef,  and  it  causes  diar- 
rhoea in  some  persons. 

Fowl,  as  chicken  or  turkey,  constitutes  a  special 
treat  on  national  holidays  and  festal  occasions.  If 
freshly  killed  and  healthy  fowls  are  served,  it  is  valu- 
able as  well  as  appetizing  food  ;  but  when  birds  long 
kept  undrawn  in  cold  storage  are  issued,  as  is  not  in- 
frequently the  case,  their  quality  should  be  suspected 
and  each  bird  carefully  scrutinized,  and,  if  of  doubtful 
appearance  or  odor,  rejected. 

Fish  vary  greatly  in  palatability  and  nutritive  value, 
but  all  of  them  keep  poorly,  especially  if  allowed  to  die 
slowly  and  if  not  packed  in  ice  or  frozen.  The  meat 
should  feel  firm  to  the  touch,  and  not  crush  on  gentle 
pi'essure.  Dried  and  canned  fish,  as  issued,  are  practi- 
cally always  good,  but  they  are  not  suitable  for  fre- 
quent or  prolonged  use,  as  men  very  soon  tire  of  them. 

Eggs  consist  of  animal  proteid  and  fat,  and  are 
classed  with  the  meats.  They  are  nutritious  and  usually 
easy  of  digestion.  They  may  be  cooked  in  a  great  va- 
riety of  ways  as  a  main  dish,  and  are  very  frequently 
used  in  other  dishes,  such  as  puddings  and  cakes. 

All  meats  should  be  eaten  cooked,  as  proper  cooking 
improves  the  flavor,  increases  digestibility,  and  destroys 


FOODS  AND  THEIR  PREPARATION        37 

parasites  that  might  otherwise  cause  disease  in  the 
eater.  Among  the  disease-producing  organisms  which 
may  be  conveyed  by  meats  but  which  can  be  destroyed 
by  heat  are  :  — 

1.  Tapeworms  of  various  kinds,  the  three  most  com- 
mon ones  being  transmitted  respectively  by  beef,  pork, 
and  fish,  the  meat  in  either  case  being  "  measly." 

2.  Trichina^  a  species  of  larval  worm  which  infests 
the  muscles,  causing  great  suffering,  and,  at  times, 
death.  It  is  conveyed  to  man  by  eating  underdone 
pork  that  contains  the  parasites. 

3.  Tubercle  bacilli^  the  cause  of  tuberculosis. 

4.  Bacteria  causing  some  animal  diseases,  which 
may  reproduce  the  same  diseases  in  man,  or  may 
merely  cause  intestinal  trouble.  Paratyphoid,  a  disease 
resembling  typhoid,  may  be  so  produced,  as  may  many 
so-called  "  acute  food  poisonings." 

6.  Ray  fungus^  the  cause  of  actinomycosis  or  lumpy 
jaw  in  cattle. 

6.  Typhoid  bacillus,  the  cause  of  typhoid  fever,  may 
be  conveyed  in  oysters  or  other  shellfish  coming  from 
polluted  waters. 

7.  The  bacillus  of  anthrax,  the  cause  of  a  very  fatal 
disease. 

8.  The  bacillus  causing  "  trembles "  in  cattle  and 
"  milk  sickness  "  in  man. 

Some  diseases  fatal  to  food  animals  do  not  affect  man, 
and  the  flesh  of  animals  dead  of  such  diseases  can  safely 
be  eaten ;  but  in  general  it  is  safe  and  wise  to  avoid  all 
such  meat,  as,  though  the  disease  killing  the  animal  may 
not  affect  man,  chemical  changes  may  have  occurred  in 
it  to  give  rise  to  poisons,  and  ptomaine  poisoning  or 
*'  meat  poisoning  "  may  result.  Ptomaine  poisoning  may 


346655 


38    THE  RECRUIT  AND  HIS  ENVIRONMENT 

also  result  from  the  action  of  bacteria  contaminating 
the  meat  after  death,  or  even  after  cooking,  and  causing 
changes  in  it.  Such  instances  are  seen  when  poisoning 
occurs  from  cold  meat  or  hash  cooked  some  days  before 
use,  or  from  canned  meat  taken  from  imperfect  tins. 
When  the  ptomaine  or  other  poisonous  products  oi 
bacterial  action  are  once  formed  in  the  meat,  they  often 
may  not  be  destroyed  by  cooking,  and  all  such  meats 
are  dangerous. 

Some  few  kinds  of  meat,  principally  fish,  are  poison- 
ous in  themselves,  and  may  cause  death. 

Meats  are  preserved  for  use  in  a  variety  of  ways,  only 
a  small  percentage  of  those  furnished  the  army  being 
used  so  soon  after  killing  as  not  to  require  some  form 
of  artificial  preservation.  Of  these  methods  of  preserv- 
ing, cold  is  the  most  satisfactory  and  best  keeps  the 
meat  unchanged,  and  by  this  means  it  may  be  kept  for 
months.  It  is  applied  so  as  to  freeze  or  merely  to  "chill" 
the  meat,  and  its  only  effects  are  to  render  the  flesh 
more  tender  and  to  detract  somewhat  from  its  flavor, 
particularly  by  causing  an  unpleasant  change  in  the 
taste  of  the  fat.  Frozen  meat  may  be  kept  indefinitely, 
but  that  which  is  merely  chilled  does  deteriorate  in 
time,  becoming  soft,  slippery,  and  flavorless.  It  should 
not  then  be  used  as  food.  Cold  cannot  be  depended 
upon  to  destroy  the  germs  or  parasites  in  meat,  though 
keeping  for  a  long  time  will  destroy  some  of  them. 

Salting^  pickling^  and  smoking  are  much  used  in 
preserving  meats,  particularly  beef  and  pork,  and  the 
results  are  very  good.  Ham,  bacon,  and  corned  or 
smoked  beef  are  excellent  and  palatable  meats  for  oc- 
casional use,  but  they  are  not  adapted  to  long  use  to 
the  exclusion  of  fresh  meats,  and  when  they  are  so  used 


FOODS  AND  THEIR  PREPARATION         39 

the  health  is  apt  to  suffer.  These  processes  tend  to 
free  the  meats  from  parasites,  but  cannot  be  depended 
upon  to  do  so,  and  the  eating  of  raw  ham  is  dangerous. 

Canning,  with  its  attendant  sterilization  of  the  meat, 
preserves  all  of  its  nutriment  and  destroys  all  parasites, 
but  it  melts  the  fat,  gelatinizes  the  gristle,  and  softens 
the  muscle,  so  that  the  meat  comes  from  the  can  less 
attractive  to  eye  or  palate,  but  it  is  good  and  valuable. 

Preservation  by  means  of  drugs  and  chemicals,  other 
than  those  used  in  pickling  or  salting,  such  as  boric  acid 
or  formalin,  is  forbidden,  and  meat  so  preserved  may 
cause  sickness  ;  but  for  emergencies  and  occasional  use 
it  would  not  ordinarily  do  so. 

It  is  not  desirable  here  to  consider  in  detail  the  vari- 
ous methods  of  cooking  meats,  but  the  company  officer 
should  exercise  a  certain  amount  of  supervision  in  the 
matter,  to  see  that  his  men's  digestion  is  not  injured 
by  an  excessive  use  of  fried  meats,  that  their  appetites 
are  not  impaired  by  poorly  prepared  or  poorly  served 
roasts,  stews,  and  hashes.  A  company  mess  is  often  good 
or  bad  as  the  cook  knows,  or  does  not  know,  how  to 
handle,  prepare,  utilize,  and  serve  meats.  Rather  com- 
mon faults  in  company  cooks  are  as  follows :  — 

Roast  or  baked  meat  is  overcooked  and  dry,  is  taken 
from  the  oven  an  hour  or  two  hours  before  meal-time 
and  sliced,  and  is  served  with  hot,  greasy  gravy  to  make 
it  warm. 

Tough  ends,  scraps,  and  bones  are  not  utilized  in 
making  soup  stock,  as  they  should  be. 

Excessive  fat  is  not  rendered  and  utilized. 

Hashes  and  stews  are  served  with  unnecessary  fre- 
quency, and  become  monotonous. 

Lack  of  imagination  or  lack  of  knowledge  on  the 


40    THE  RECRUIT  AND  HIS  ENVIRONMENT 

part  of  the  cook  and  mess-sergeant  result  in  lack  of 
variety  and  attractiveness  of  the  mess.  Intelligent 
supervision  of  the  mess  by  the  company  commander, 
the  preparation  of  bills  of  fare  in  advance,  so  as  to  in- 
sure variety,  and  the  study  of  good  cook-books  will 
obviate  this. 

The  principal  carbohydrate  food  is  bread,  and  its 
importance  in  the  mess  is  scarcely,  if  at  all,  secondary 
to  that  of  meat.  The  ordinary  supply  of 
bread  is  issued  as  such,  and  its  quality 
depends  largely  on  the  capacity  of  the  post  baker, 
notwithstanding  his  proneness  to  credit  any  defects 
in  it  to  the  flour,  the  yeast,  the  hops,  or  the  oven.  The 
materials  supplied  by  the  government  are,  with  rare 
exceptions,  excellent,  and  the  failure  to  produce  good 
bread  is  usually  to  be  attributed  to  either  the  ignorance, 
the  carelessness,  or  the  uncleanliness  of  the  baker. 
With  the  proper  training  of  the  bakers  such  failures 
will  seldom  be  seen.  Company  cooks  are  permitted, 
and  should  be  encouraged,  to  bake  biscuit  and  muffins 
occasionally.  They  are  somewhat  more  difficult  of 
digestion  than  good  issue  bread,  but  are  much  liked 
and  add  to  the  attractiveness  of  the  mess.  Stale  bread 
(that  is,  more  than  twenty-four  hours  old)  is  somewhat 
more  digestible  than  fresh  or  hot  bread ;  but  during 
the  process  of  staling  it  should  be  kept  covered  and 
protected  from  dust,  and  should  not  be  unnecessarily 
handled,  nor  by  any  but  clean  hands ;  otherwise  bac- 
teria and  moulds  finds  lodgment  and  growth  upon  it 
and  may  produce  disease.  Toasting  improves  some 
breads  and  adds  to  their  digestibility,  but  it  is  not 
often  done  in  companies. 

Pastries  and  cake  are  also  bread,  but  are  less  easily 


FOODS  AND  THEIR  PREPARATION         41 

digestible  than  the  ordinary  forms.  They  add  much  to 
the  attractiveness  of  a  mess  and  should  be  served  occa- 
sionally. The  same  remarks  apply  to  the  various  kinds 
of  batter-cakes. 

Comhread  also  makes  a  pleasant  change  from  the 
monotony  of  baker's  bread,  and,  as  it  is  cheap,  palat- 
able, and  nourishing,  its  use  is  to  be  encouraged. 

Corn-meal  mush,  with  butter  or  milk,  is  also  relished, 
and  when  cold  may  be  sliced  and  fried. 

Hard  bread  is  issued  only  for  field  use.  Good  teeth 
are  necessary  for  its  utilization  as  issued,  but  it  may 
be  softened  in  hot  water  or  coffee  without  impairing 
its  value. 

A  measure  of  economy,  sometimes  ignored,  is  the 
utilization  of  crusts  and  fragments  of  stale  bread  in 
puddings,  as  meat-stuffing,  and  in  other  ways.  Such 
practices  add  to  the  variety  and  attractiveness  of  the 
mess,  and  allow  savings  to  be  made  in  other  direc- 
tions. To  throw  away  such  crusts  because  sugar  and 
eggs  are  necessary  in  puddings  and  cost  a  little  extra, 
is  wasteful  and  wrong. 

Vegetables  supply  all  classes  of  foods,  and  are  very 
important  in  the  soldier's  mess   for  this  reason,  and 
because  they  serve  to  impart  variety  and     _- 
attractiveness  to  it.   The  most  important     .    y^ 
vegetable  issued  (except  wheat)  is  the  po- 
tato^ which  consists  of  almost  pure  starch.  It  may  be 
cooked  in  a  much  greater  variety  of  ways  than  is  usual 
in  most  companies,  and  the  company  commander  should 
see  that  such  is  the  case.  In  whatever  way  they  are  pre- 
pared, potatoes  should  be  cooked  until  soft  or  mealy, 
and  should  be  served  hot. 

Rice  is  another  valuable  starchy  food,  and  in  some 


42    THE  RECRUIT  AND  HIS  ENVIRONMENT 

parts  o£  the  world  it  is  the  main  article  of  diet;  but  in 
our  country  it  is  much  less  used  and  less  desired  than 
bread  or  potatoes.  It  is  most  popular  with  soldiers  as 
a  pudding,  though  it  may  be  prepared  in  a  variety  of 
ways.  It  should  be  used  to  give  variety  and  served  in 
attractive  forms,  cooked  with  tomatoes  or  something 
else  to  take  away  its  insipidity.  Undermilled  rice  has 
a  flavor  superior  to  that  of  the  highly  milled  and  is 
also  preferable,  especially  when  used  as  a  main  article 
of  diet,  because  of  its  content  of  vitamines  that  ai*e  lack- 
ing from  the  latter. 

Com  is  also  to  be  classed  as  a  starchy  food.  Ripe 
corn  in  the  whole  or  the  broken  grain,  as  hominy  or 
grits,  is  not  so  generally  liked  as  the  green,  but  it  is 
very  nutritious,  and  should  be  used  occasionally  as  a 
principal  dish. 

Macaroni  and  other  paste  preparations  are  valuable 
foods,  and  admit  of  a  variety  of  presentations,  so  that 
their  use  should  be  encouraged. 

Onions  are  a  staple  article  of  issue,  and  are  much 
used  in  the  army.  Their  nutritive  value  is  much  less 
than  that  of  the  articles  just  discussed,  but  their  flavor 
and  the  variety  of  ways  in  which  they  may  be  used 
make  them  very  valuable.  Monotony  should  be  avoided 
in  their  use. 

Tomatoes^  likewise,  have  relatively  little  food-value, 
but  stand  high  for  their  flavor  and  the  variety  they 
afford.  When  they  are  served  cooked,  it  should  often 
be  with  some  otherwise  insipid  food,  such  as  rice,  maca- 
roni, or  stale  bread. 

Beans  andj^eas,  though  possessing  considerable  starch, 
are  the  principal  sources  of  vegetable  proteid.  They 
are  both  very  attractive  and  palatable  in  the  green  state, 


FOODS   AND   THEIR  PREPARATION        43 

and,  though  less  nutritious  than  when  ripe,  add  much  to 
the  mess.  When  dried,  they  are  particularly  valuable 
in  making  soup  (for  use  in  which  ham-bones  and  rinds 
should  always  be  saved),  and  when  served  boiled  or 
baked,  with  bacon. 

Beets  are  another  valuable  source  of  food,  as  they 
contain  much  sugar.  They  are  also  cheap,  and  are 
relished  by  most  men. 

Most  of  the  common  vegetables,  as  cabbage,  greens, 
carrots,  spinach,  radishes,  and  cucumbers,  have  little 
nutritive  value,  but  they  add  greatly  to  the  attractive- 
ness of  the  mess  and  are  also  valuable  in  preserving 
health  and  preventing  scurvy,  and  their  use  should  be 
encouraged. 

Their  lack  and  the  consequent  occurrence  of  scurvy 
are  apt  to  be  matters  of  vital  importance  in  sieges. 

Salads  are  not  used  in  company  messes  as  much  as 
they  should  be.  They  afford  pleasing  variety,  and  may 
be  made  to  constitute  an  important  dish,  as     «  ,    , 
when  composed  principally  of  potatoes  or 
salmon. 

As  issued  in  company  messes,  desserts  are  nearly  al- 
ways very  simple,  and  such  is  necessarily  the  case. 
When  practicable,  a  dessert  should  be  fur- 
nished  once  a  day,  and  it  may  be  made  to 
use  up  otherwise  unattractive  articles,  such  as  rice  or 
stale  bread  made  into  puddings.  Pies  made  of  fresh 
or  dried  fruits  are  easy  to  make  and  serve,  are  inex- 
pensive, and  well  liked. 

Milh  and  its  products  constitute  important  articles  of 
food,  though  not  entering  so  largely  into     «-.,. 
the  soldier's  dietary  as  they  might.  Milk 
contains  all  classes  of  food, — proteid,  fat,  carbohydrate, 


44    THE  RECRUIT  AND  HIS  ENVIRONMENT 

water,  and  salts,  —  though  not  in  the  proportions  desir- 
able in  maintaining  adult  life.  Fresh  milk  is  both  more 
palatable  and  more  wholesome  than  the  canned  or  con- 
densed article,  if  its  purity  and  freedom  from  disease- 
producing  germs  can  be  assured,  but  unfortunately  this 
is  not  always  the  case.  It  should  be  borne  in  mind  that 
many  serious  diseases  may  be  conveyed  in  milk,  among 
them  tuberculosis,  typhoid  fever,  dysentery,  diphtheria, 
septic  sore  throat,  and  scarlet  fever,  —  some  of  the  dis- 
eases most  dreaded  in  military  life.  Milk  sickness,  a 
disease  now  rarely  seen,  was  also  conveyed  in  that  way ; 
while  for  many  years  the  Mediterranean  garrisons  of 
the  British  army  suffered  very  seriously  from  Malta 
fever,  now  known  to  have  been  transmitted  by  means 
of  goats'  milk. 

In  case  of  epidemic  of  any  of  the  above-named 
diseases,  the  milk  supply  should  be  investigated,  and 
this  is  particularly  suggested  by  outbreaks  of  typhoid 
showing  an  explosive  character,  that  is,  epidemics  in 
which  many  cases  occur  almost  simultaneously.  Because 
of  this  possibility  of  disease-production,  milk  whose 
origin  and  condition  are  not  above  reproach  should  be 
used  in  companies  and  post  exchanges  only  in  cooking 
or  after  boiling,  and  in  camp  or  on  the  march  men 
should  be  cautioned  to  the  same  effect,  and  warned 
against  purchasing  it  by  the  glass  from  dealers  or  ped- 
dlers. Condensed  or  evaporated  milk  is  more  gener- 
ally used  in  companies  than  the  fresh  article,  and  it  is 
on  the  whole  probably  safer,  as  the  process  of  conden- 
sation and  the  subsequent  prolonged  storage  tend  to 
destroy  disease-producing  organisms.  A  can  of  such 
milk,  when  once  opened,  should  either  be  used  promptly 
or  kept  cool  and  protected  from  dust  until  used.   Boil- 


FOODS  AND  THEIR  PREPARATION        45 

ing  water  should  be  used  to  dilute  it,  to  kill  germs 
that  may  have  settled  and  grown  on  it  after  the  open- 
ing of  the  can. 

Buttermilk  is  a  valuable  and  pleasant  drink,  and 
where  it  can  be  obtained  is  much  relished  by  the  men. 

Good  butter  is  made  from  good  cream  and  is  every- 
where highly  appreciated  ;  but  unfortunately  the  good 
quality  is  not  always  obtainable,  and  much  very  poor 
butter  is  used  in  company  messes.  Oleomargarine  is 
little  inferior  to  butter  in  nutritive  qualities  and  is  to  be 
preferred  to  poor  butter,  except  that  a  prejudice  exists 
against  it  in  this  country  and  men  are  apt  to  avoid  its 
use.  It  has  an  advantage  over  butter  in  that  it  is  not 
so  likely  to  act  as  a  carrier  of  disease  germs. 

Both  are  valuable  fat  foods  as  well  as  relishes,  and 
should  not  be  regarded  merely  in  the  latter  light. 

Cheeses  are  very  concentrated  forms  of  food,  con- 
taining about  one  third  proteid  and  one  third  fat, 
though  the  different  varieties  differ  in  the  percentages 
of  these.  They  make  agreeable  and  valuable  additions 
to  the  mess,  but  are  seldom  used  in  large  quantities 
because  they  are  apt  to  be  difficult  to  digest,  and  to 
cause  constipation.  Ordinarily  they  are  used  in  compa- 
nies rather  as  a  condiment  than  for  their  food-values, 
though  at  times  they  may  constitute  an  important  part 
of  a  meal.  In  cooking,  cheese  is  used  principally  with 
macaroni.  Milk  and  cheese  are  liable  to  certain  changes 
which  cause  the  development  of  poisons,  one  of  these 
known  as  tyrotoxicon,  being  very  powerful  and  produc- 
ing severe  symptoms  or  death.  The  ordinary  souring  of 
milk  is  not  in  itself  dangerous,  but  may  be  beneficial 
in  some  respects.  The  justification  for  regarding  sour 
milk  with  suspicion  lies  in  the  fact  that  the  conditions 


46    THE  RECRUIT  AND  HIS  ENVIRONMENT 

favoring  the  development  of  the  bacteria  causing  the 
souring  may  also  have  favored  the  development  of  dis- 
ease-producing organisms.  Milk  should  be  preserved 
either  by  refrigeration,  to  prevent  the  growth,  or  by 
heating,  to  kill,  the  contained  bacteria. 

For  preserving  other  foods  than  meats  and  milk, 
refrigeration,  canning,  and  drying  are  the  three  great 
commercial  methods.  Cold  storage  may  pre- 
serve  fruits  and  vegetables,  as  well  as  meats, 
eggs,  and  milk,  practically  unchanged  for 
weeks,  and  immense  quantities  are  so  preserved  and 
sold.  Of  even  greater  importance,  however,  is  the  pro- 
cess of  canning,  whereby  the  articles  are  cooked,  ster- 
ilized, and  hermetically  sealed  in  cans  or  jars,  to  be 
preserved  for  months  or  years.  This  industry  has  in- 
creased enormously,  and   is  now  applied  to  almost  all 
of  the  articles  of  food  that  have  been  discussed  herein, 
and  to  a  great  number  of  others  not  so  discussed. 

The  results  obtained  are  excellent,  and  such  foods 
are  carried  to  all  parts  of  the  world  and  enjoyed. 

Canned  foods  pall  after  a  time,  though,  and  should 
never,  if  it  can  be  avoided,  be  used  to  the  exclusion  of 
fresh  food.  Otherwise  nutrition  may  be  impaired,  and 
even  scurvy  may  result.  This  may  be  because  the  heat 
necessary  to  preserve  them  destroys  the  vitamine  that 
prevents  scurvy.  The  fear  of  metallic  poisoning  from 
canned  foods  is  thought  to  be  exaggerated,  and  the 
probability  of  such  poisoning  to  be  remote,  except  where 
lead  is  used,  and  that  is  infrequent  and  does  not  apply 
to  the  great  bulk  of  canned  foods  used  by  the  soldier. 
Drying  as  a  method  of  preservation  is  applied  to 
fruits  and  vegetables,  as  well  as  to  meats  and  fish. 
Desiccated  vegetables  find  some  use  in  the  army,  par- 


FOODS  AND  THEIR  PREPARATION         47 

ticularly  in  Alaska,  where  they  constitute  a  real  bless- 
ing, but  their  use  is  not  general. 

Dried  fruits,  however,  are  everywhere  used  and  with 
very  general  satisfaction.  Dried  apples,  peaches,  prunes, 
and  raisins  are  issued  or  sold  by  the  Subsistence  De- 
partment, and  make  valuable  and  pleasing  additions  to 
the  mess,  where  they  are  served  stewed  or  in  puddings 
and  other  desserts. 

Sweets  are  much  enjoyed  by  the  men,  and  are  valu- 
able for  their  fuel- value,  and  also,  probably,  as  lessen- 
ing a  craving  for  alcohol.  Syrup  and  jam  o-^eetg 
are  articles  of  the  ration  that  are  much  en- 
joyed, while  the  sale  of  candy  by  the  Quartermaster's 
Department  shows  that  its  worth  is  recognized.  As 
stated  before,  an  excess  of  sugar  causes  dyspepsia  and 
should  be  guarded  against. 

Coffee,  tea,  and  cocoa  are  mild  stimulants,  but  may 
almost  as  well  be  classed  with  condiments.  Of  the  three, 
coffee  is  the  only  one  extensively  used  in     5^^^-. 
our  service,  and  it  is  often  poorly  made  and     _  ___ 
poorly  served.    The   green  issue  coffee  is 
of  excellent  grade,  and  if  properly  roasted  and  ground, 
and  used  fresh,  is  superior  to  most  higher  priced  coffees 
obtained  elsewhere  ready  roasted.    The  preparation  of 
good  coffee  is  simple  and  easy,  but  most  company  cooks 
do  not  practice  it.    The  company  commanders  should 
make  sure  that,  in  addition  to  proper  steps  in  prepara- 
tion, the  following  are  observed  :  — 

The  coffee  must  not  be  long  boiled. 

The  coffee-pot  must  be  emptied  and  cleaned  after 
each  meal,  and  no  coffee  grounds  should  be  used  twice. 

The  sugar  and  milk,  if  the  latter  be  served,  should 
be  put  in  by  the  user  and  not  served  alike  to  all. 


48    THE  RECRUIT  AND  HIS  ENVIRONMENT 

Enough  coffee  should  be  used  to  give  strength  and 
flavor  to  the  beverage,  and  then  but  a  moderate  amount 
of  it  should  be  served  to  each  man. 

In  the  field,  where  the  water  is  of  a  doubtful  char- 
acter, the  issue  of  large  amounts  of  weak  coffee  is  justi- 
fied, as  tending  to  reduce  the  amount  of  unboiled  water 
used ;  but  in  posts  this  is  not  necessary. 

Cooks  will  insist  that  the  men  prefer  their  coffee 
weak,  long-boiled,  and  ready  sweetened,  just  as  they 
will  say  that  they  prefer  roast  beef  overcooked,  dry,  and 
swimming  in  greasy  gravy  ;  but  inasmuch  as  most  men 
in  civil  life  like  to  exercise  a  choice  in  such  matters,  it 
is  thought  that  a  like  privilege  might  be  appreciated  in 
the  service. 

It  is  also  thought  that  perhaps  the  use  of  tea  in  the 
service  might  become  more  general  if  the  beverage  were 
properly  made,  and  not  boiled  or  steeped  until  a  strong, 
black  tannin  solution  results. 

The  following  is  a  bill  of  fare  for  one  week,  which, 
it  has  been  demonstrated,  can  be  supplied  with  little 
extra  cost  beyond  the  savings  on  the  ration,  provided 
that  the  cook  is  capable  and  careful  and  the  mess-ser- 
geant intelligent.  Slight  variations  from  week  to  week 
and  to  suit  the  seasons  will  permit  such  a  bill  of  fare 
to  be  used  for  a  long  period  and  give  satisfaction. 

MONDAY 

Breakfast :  Stewed  Fruit,  Fried  Eggs,  Bacon,  Bread, 
and  Coffee. 

Dinner :  Roast  Beef,  Steak,  or  Meat  Balls ;  Baked 
Potatoes,  Squash  or  Turnips,  Stewed  Tomatoes ;  Pie  or 
Cake. 


FOODS  AND  THEIR   PREPARATION        49 

Supper :  Cold  Sliced  Beef,  Fried  Onions  or  Toma- 
toes, Bread  and  Jam,  Tea  or  Coffee. 


TUESDAY 

Breakfast :  Bananas  or  Fresh  Fruit,  Liver  or  Kid- 
ney with  Bacon,  Bread,  Butter,  and  Coffee. 

Dinner :  Beef  Steak  or  Hamburger  Steak ;  Potatoes, 
Radishes,  or  Onions  ;  Pudding,  Bread,  and  Coffee. 

Supper:  Cold  Beef,  Fried  Potatoes,  Bread  and  Jam, 
Tea  or  Coffee. 

WEDNESDAY 

Breakfast :  Stewed  Fruit,  Fried  Mush  and  Molasses, 
Coffee. 

Dinner:  Boiled  Ham;  Boiled  Potatoes,  Boiled  Cab- 
bage ;  Pudding,  Bread,  and  Coffee. 

Supper :  Cold  Boiled  Ham,  Bread  and  Jam,  Butter, 
Tea  or  Coffee. 

THURSDAY 

Breakfast :  Stewed  Fruit,  Puffed  Rice,  Wet  Hash 
on  Toast. 

Dinner :  Roast  Beef,  Steak,  or  Meat  Balls  ;  Baked 
Potatoes,  Corn,  Squash,  or  Turnips  ;  Pudding,  Bread, 
and  Coffee. 

Supper :  Cold  Beef  or  Hash,  Bread  and  Jam,  Fried 
Onions  or  Tomatoes,  Tea  or  Coffee. 

FRIDAY 

Breakfast :  Stewed  Fruit,  Oatmeal  with  Milk,  Bis- 
cuits with  Syrup  and  Coffee. 

Dinner:  Baked  Fish  with  Sauce;  Boiled  Potatoes 
and  Onions ;  Bread,  Butter,  and  Coffee. 


60    THE  RECRUIT  AND  HIS  ENVIRONMENT 

Supper :  Salmon  or  other  Fish  Salad,  Bread  and  Jam, 
Tea  or  Coffee. 

SATURDAY 

Breakfast :  Stewed  Fruit,  Bacon,  Rice  or  Corn  Flakes, 
Toast,  and  Coffee. 

Dinner :  Baked  Beans  with  Pork ;  Pickles,  Stewed 
Tomatoes ;  Bread  and  Coffee. 

Supper:  Cold  Beans  or  Bean  Soup,  Pickles,  Tomato 
Catsup,  Bread,  Butter,  and  Coffee. 

SUNDAY 

Breahfast :  Stewed  Fruit,  Oatmeal  with  Milk,  Hot 
Biscuits,  Coffee. 

Dinner :  Roast  Pork,  Veal,  or  Mutton ;  Browned  Po- 
tatoes, Baked  Squash ;  Apple  Sauce,  Pie  or  Cake. 

Supper :  Cold  Meat,  Bread  and  Jam,  Tea  or  Coffee. 

The  Hygiene  of  the  Kitchen 
From  the  hygienic  and  many  other  points  of  view  the 
company  kitchen  is  one  of  the  most  important  places 
in  the  post,  and  the  company  cook  a  very  important 
person. 

These  two  bear  a  more  direct  relation  to  the  guard 
reports,  sick  reports,  and  the  general  efficiency  of  the 
command  than  at  first  appears ;  while  the  subjects  of 
alcoholism  and  desertion  are  especially  involved. 

It  is  therefore  an  important  part  of  the  company  com- 
mander's duties  to  see  that  both  are  as  good  as  can  be 
obtained.  He  should  see,  as  stated  before,  that  his  cook 
is  capable  of  preparing  the  food  in  attractive,  satisfy- 
ing, and  digestible  forms,  that  he  is  economical,  a  good 
manager,  and  can  utilize  the  ration  in  a  variety  of  ways 
and  supplement  it  judiciously.  But  the  cook  may  fulfill 


FOODS  AND  THEIR  PREPARATION        51 

these  requirements  and  still  do  much  harm  by  causing 
or  spreading  disease.  Therefore  he  and  his  company 
officers  should  know  something  of  the  hygiene  of  the 
kitchen. 

The  primary  and  most  important  rule  as  to  cook, 
kitchen,  and  the  contents  and  surroundings  of  the  latter, 
is  cleanliness.  All  parts  of  the  barracks  and 
all  persons  therein  should  be  clean,  but  the 
kitchen  and  the  cook  should  excel.  The  cook  should 
bathe  often,  change  his  clothing  frequently,  always 
wash  his  hands  after  a  visit  to  the  toilet,  after  handling 
anything  dirty,  and  before  handling  foods.  He  should 
always  have  a  clean  hand-towel  in  his  kitchen,  and  not 
use  for  the  purpose  either  a  dirty  rag  or  his  dish-towels. 
He  should  wear  white  aprons,  caps,  and  clothing,  and 
change  them  when  soiled.  His  finger-nails  and  his  hair 
should  be  kept  short  and  clean,  and  a  nail-brush  should 
be  in  the  kitchen  for  use  and  should  be  scalded  daily. 
A  cook  who  has  had  typhoid  fever,  or,  rarely,  one  who 
does  not  know  that  he  has  had  it,  may,  though  appar- 
ently in  good  health,  be  excreting  and  distributing 
typhoid  bacilli ;  and  a  typhoid  epidemic  limited  to  a 
company  should  always  cause  this  possibility  to  be 
investigated.  Men  who  are  dirty  in  their  habits,  who 
have  syphilis,  tuberculosis,  or  other  infectious  dis- 
eases, or  who  are  persistent  in  unsanitary  or  careless 
methods  of  preparing  foods,  should  not  be  allowed  to 
cook. 

The  kitchen  should  be  proof  against  the  most  rigid 
inspection  for  dirt.  Some  disorder  and  litter  necessarily 
attend  the  preparation  of  food ;  but  this  can  usually  be 
cleared  up  almost  immediately,  and  it  should  not  remain 
any  longer  than   necessary.    The  meat-block,  bread- 


62    THE  RECRUIT  AND  HIS  ENVIRONMENT 

boards,  carving-tables,  and  all  utensils  should  all  be  in- 
spected daily  and  all  kept  clean. 

The  ice-chest  and  milk-cans  should  receive  special 
scrutiny,  and  should  be  clean  inside  and  out,  as  evi- 
denced to  the  eye,  the  nose,  and  the  white  glove. 

Foods  like  cheese,  codfish,  and  bacon,  that  possess  a 
strong  odor  and  do  not  readily  spoil,  should  be  kept  on 
shelves  or  in  boxes,  protected  by  wire  gauze,  rather  than 
in  the  ice-chest.  Canned  meats,  fruit,  and  vegetables 
should  be  used  as  soon  as  possible  after  they  are  opened, 
or  emptied  into  clean  dishes,  and  not  left  about  in  the 
cans.  All  food  should  be  used  before  it  becomes  mouldy, 
sour,  or  decomposed,  or  should  be  thrown  away,  though 
a  slight  and  recent  growth  of  mould  on  the  surface  of 
ham,  cold-storage  beef,  bread,  jam  or  other  sweets 
does  not  necessarily  injure  the  whole,  and  may  be  re- 
moved. 

The  kitchen  sinks  should  always  be  kept  clean,  and 
should  be  well  trapped.  Care  should  be  exercised  that 
grease,  crumbs,  and  fragments  are  kept  out  of  them, 
that  the  pipes  may  not  become  clogged.  Kitchen  waste, 
the  scrapings  of  food  from  plates,  and  unused  frag- 
ments should  be  thrown  into  covered  cans,  which  should 
be  emptied  and  cleaned  once  daily,  and  should  not  serve 
either  as  a  breeding  or  a  feeding  place  for  flies,  roaches, 
rats',  or  other  vermin.  Particular  care  should  be  exer- 
cised to  exclude  all  such  from  the  kitchen  at  all  times. 
For  this  purpose  cleanliness  and  screens  should  suffice, 
but  if  fly-paper,  roach-poison,  and  rat-traps  are  needed, 
they  should  be  supplied. 

The  kitchen  police  is  usually  supplied  by  roster  from 
the  company,  but  at  times  the  work  is  given  as  a  pun- 
ishment.  This  is  undesirable.  Instead  of  poor  men. 


FOODS   AND  THEIR  PREPARATION        53 

good  ones  should  be  put  on  kitchen  police,  and  the  work 
should  carry  with  it  immunities  and  privileges  to  make 
good  men  desire  it. 

Men  who  are  sick  should  be  excluded  from  duty  in 
the  kitchen.  In  1909  the  writer  investigated  an  epi- 
demic of  typhoid  in  a  battery  of  mountain  artillery  at 
Fort  D.  A.  Russell,  and  found  that  its  spread  was  due 
to  the  fact  that  certain  men  were  on  duty  as  kitchen 
helpers  at  the  time  when  they  were  in  the  early  days  of 
typhoid  attacks.  They  infected  their  comrades  by  han- 
dling food  that  these  ate. 


CHAPTER  IV 

THE  HYGIENE  OP  THE  BARRACKS 

Neither  the  enlisted  man  nor  his  immediate  com- 
mander has  very  much  choice  in  the  matter  of  bar- 
racks. They  are  assigned  to  duty  at  a  post  where 
certain  barracks  are  provided,  and  must  of  necessity 
make  use  of  them.  In  one  post  the  barracks  may  be 
new,  large,  and  built  with  a  view  of  affording  all  pos- 
sible advantages  in  the  way  of  comfort,  convenience, 
and  sanitary  arrangements.  In  another  post  they  may 
be  old,  small,  and  apparently  built  without  a  thought 
of  any  of  the  advantages  mentioned.  In  the  one  the 
capacity  of  the  barracks  may  greatly  exceed  the  size 
of  the  garrison,  in  the  other,  the  reverse  may  obtain ; 
but  in  nearly  all  instances  the  conditions  are  controlled 
by  military  necessity  and  not  by  the  company  com- 
manders. It  is  therefore  considered  that  the  proper 
scope  of  this  chapter  is  to  indicate  what  is  desirable, 
and  to  assist  in  making  the  nearest  practicable  ap- 
proach to  it  under  existing  conditions. 

The  buildings  are  apt  to  be  of  almost  any  material, 

from  brick,  stone,  or  concrete,  to  nipa  and  thatch. 

.  Usually  they  are  of  substantial  materials 

and  well  constructed,  unless  designed  for 
ings  ,  .  . 

merely  temporary  use  m  warm  countries, 

when  light  board-structures  or  those   of  bamboo  and 

palm  are  used.    In  the  latter  class,  cheapness  of  cost 

is  always  a  consideration ;  but  it  is  not  to  be  carried 

to  the  extent  of  making  the  structures  unsanitary.    Suf- 


THE  HYGIENE  OF  THE  BARRACKS        55 

ficient  room  should  be  provided,  adequate  and  conven- 
ient supplies  of  good  water,  proper  kitchen  arrange- 
ments, and  protection  from  mosquitoes,  flies,  and  other 
insect  pests.  The  structures  should  be  sufficiently  raised 
above  the  ground  to  prevent  dampness,  if  pobsible,  and 
ample  provision  should  be  made  for  the  care  of  excreta, 
garbage,  and  waste  water. 

In  permanent  barracks  of  the  newer  type,  provision 
has  usually  been  made  for  the  sanitary  requirements, 
and  the  conditions  are  satisfactory  where  overcrowd- 
ing does  not  obtain.  Barracks  of  concrete,  stone,  brick, 
or  wood  may  all  be  satisfactory  if  other  considerations 
are  met.  One  of  the  first  of  these  is  location  and  ex- 
posure, and  the  desirable  locations  and  facings  vary 
with  climate  and  local  conditions. 

In  general,  it  is  well  to  get  much  exposure  to  the 
sun  in  cold  climates,  and  this  is  best  accomplished  by 
having  the  four  corners  of  the  main  building  point 
in  the  cardinal  directions.  In  such  places,  however, 
the  avoidance  of  prevailing  winter  winds  may  be  of 
even  greater  importance,  and  may  dictate  a  location. 
In  any  event,  both  sun  and  wind  must  be  considered  in 
their  sanitary  as  well  as  their  comfort-bearing  capacities, 
the  former  as  a  great  aid  in  cleanliness  and  disinfec- 
tion, the  latter  as  a  promoter  of  ventilation.  In  any 
climate,  the  structures  should  be  dry  as  to  both  site 
and  walls.  Damp  cellars  and  surroundings  may  be 
avoided  by  selection  or  by  grading  and  drainage.  Damp 
walls  are  avoided  by  having  a  damp-proof  course,  as 
of  slate  or  concrete,  above  the  foundations,  by  double 
walls  with  air-spaces,  by  good  ventilation,  and,  where 
excessive  or  hard-driven  rains  obtain,  by  waterproofing 
with  paint,  etc.  If  the  walls  are  continuously  of  porous 


56    THE  RECRUIT  AND  HIS  ENVIRONMENT 

brick  or  stone  to  the  cellar,  or  to  the  surface  of  the 
ground,  they  will  be  continuously  damp  and  chilly,  in 
most  climates,  and  only  the  insertion  of  a  damp-proof 
course  will  correct  the  condition.  If  other  considera- 
tions, such  as  size,  ventilation,  heating,  or  plumbing, 
are  unequal,  they  should  be  allowed  more  weight,  in 
governing  the  choice  of  barracks,  than  the  structural 
material ;  if  all  other  considerations  are  equal,  the 
structural  feature  should  govern  choice,  usually  in  the 
following  order :  concrete,  brick,  stone,  wood. 

The  buildings  should  be  sufficiently  large  to  provide 
abundant  squad  room,  recreation  or  day  rooms,  store- 
_-  rooms,  kitchen,  pantry,  and  dining-rooms, 

small  rooms  for  noncommissioned  officers, 
tailor's,  barber's,  and  cobbler's  shops,  a  workshop  for 
the  mechanics,  and  ample  water-closet  and  bathing 
facilities,  unless  a  part  of  these  are  provided  else- 
where. 

The  squad-rooms  are  the  matter  of  greatest  consid- 
eration, and  they  should  be  given  first  thought  in 
selecting  barracks.  They  should  always  be  as  large  as 
it  is  possible  to  obtain,  keep  clean,  and  heat,  and 
should  provide  a  minimum  of  six  hundred  cubic  feet 
of  space  and  sixty  square  feet  of  floor-room  for  each 
man,  exclusive  of  the  room  occupied  by  wardrobes  and 
lockers.  They  should  be  well  lighted  both  by  windows 
and  artificial  light,  preferably  electric.  The  window- 
space  necessary  will  vary  with  climate  and  location, 
but  it  should  insure  plenty  of  breeze  in  the  tropics, 
and  plenty  of  light  in  northern  climates.  If  a  good 
system  of  ventilation,  other  than  by  windows  and  doors, 
has  been  installed,  so  much  the  better,  and  it  should 
be  carefully  studied  until  understood,  and  then  kept  in 


THE  HYGIENE  OF  THE  BARRACKS        57 

maximum  working  order.  In  all  barracks,  ventilation 
and  heating  are  closely  related,  and  should  receive  the 
company  commander's  personal  consideration.  If  it 
be  practicable,  it  is  a  great  help  in  ventilating  most 
barracks  to  have  a  small  open-grate  fire  going  all  win- 
ter, but  there  is  usually  no  provision  for  it.  The  air  ia 
the  squad-rooms  should  at  all  times  be  sweet  and  fresh, 
and  free  from  the  "closeness"  and  staleness  that  is 
particularly  apt  to  obtain  in  the  early  morning  hours 
of  winter  nights.  The  means  of  insuring  this  will  vary 
in  different  places,  but  there  is  always  one  expedient 
that  may  be  resorted  to,  —  raising  the  lower  window- 
sashes  and  fixing  boards  beneath  them,  with  nails  if 
necessary,  so  as  to  allow  the  air  to  enter  in  an  upward 
direction  between  the  two  sashes.  Inspections  should 
be  made  occasionally,  at  the  times  indicated,  to  see  that 
the  air  is  good;  while  all  arrangements  to  promote 
ventilation  should  be  inspected  frequently  to  see  that 
they  are  in  working  order  and  have  not  been  interfered 
with.  In  case  interference  is  found,  it  is  well  to  detail 
a  man  in  each  room  to  be  responsible  for  their  correct 
maintenance.  All  squad-rooms  should  be  opened  and 
thoroughly  aired  each  day,  in  addition  to  the  constantly 
working  arrangements. 

Always  in  the  tropics,  and  during  warm  weather  in 
other  climates,  all  windows  should  be  provided  with 
screens  to  exclude  flies  and  mosquitoes.  If  such  is  not 
the  case,  bed -nets  must  be  used  at  night. 

In  cold  climates  double  or  storm  doors  and  windows 
may  be  provided.  They  make  the  rooms  more  com- 
fortable and  easier  to  heat,  but  should  not  be  allowed 
to  impair  the  ventilation. 

Water-closets,  bath-rooms,  and  wash-basins  should 


58    THE  RECRUIT  AND  HIS  ENVIRONMENT 

be  entirely  away  from  the  squad-rooms,  in  which  no 
plumbing  should  show.  Articles  of  food,  dirty  and  wet 
clothing,  and  useless  trappings  should  be  excluded  as  far 
as  practicable.  Floors  should  be  sprinkled  frequently 
with  wet  sawdust,  and  swept  so  as  to  create  as  little  dust 
as  possible;  and  at  least  once  a  week  the  entire  room 
and  its  contents  should  be  so  thoroughly  cleaned  as 
to  pass  the  most  rigid  inspection,  no  dirt,  dust,  disorder, 
or  vermin  being  anywhere  present.  This  inspection 
will  be  made  usually  on  Saturday,  and  should  be  pre- 
ceded by  an  outdoor  airing  of  bedding  and  change  of 
bed-linen  on  Friday.  At  the  inspection  all  wardrobes, 
drawers,  lockers,  and  boxes  should  be  opened,  and 
their  contents  exposed  to  view.  The  small  spaces  and 
corners  about  such  articles,  the  space  behind  or  under 
radiators,  the  tops  of  wardrobes  and  shelves,  should  all 
be  examined,  and,  if  any  man  seem  unclean,  his  linen 
and  person.  It  is  not  thought  wise  to  subject  intelligent 
and  self-respecting  men  to  such  personal  inspections 
as  a  matter  of  routine. 

The  day-rooms,  or  recreation-rooms,  should  be  suit- 
able for  their  purpose,  should  have  good  light,  good 
air,  comfortable  heating,  and  such  provision  in  the 
way  of  chairs,  tables,  reading  matter,  billiard  and  pool 
tables,  and  other  facilities  for  amusements,  as  will  con- 
duce to  the  interest,  instruction,  and  amusement  of  the 
men,  or  such,  at  any  rate,  as  can  be  obtained. 

These  rooms  should  be  kept  clean  and  neat  at  all 
times,  free  from  dust,  foul  air,  dirt,  and  vermin.  The 
care  should  be  such  as  to  enable  them  to  pass  the  same 
general  inspection  as  squad-rooms.  Smoking  will  be 
indulged  in,  in  recreation-rooms,  at  most  times  of  day, 
but  the  rooms  should  be  opened  and  aired  frequently. 


THE  HYGIENE  OF  THE  BARRACKS        59 

Spitting  will  also  be  indulged  in,  and  cuspidors  con- 
taining water  should  be  provided  in  sufficient  numbers 
to  prevent  spitting  on  the  floor,  and  any  man  then 
doing  so  should  be  punished.  The  cuspidors  should  be- 
emptied  and  scrubbed  daily. 

Pictures  and  ornaments  may  be  permitted  to  some 
extent,  to  detract  from  the  bareness  and  add  to  the 
cheerfulness  of  the  room ;  but,  in  general,  unnecessary 
dust-collecting  articles  should  be  excluded. 

The  dining  or  mess  room  should  be  sufficiently  large 
to  seat  comfortably  at  table  at  least  ninety  per  cent  of 
the  command.  A  certain  number  of  men  will  necessarily 
be  absent  from  each  meal, —  on  guard,  in  the  kitchen, 
on  pass  or  furlough,  and  for  other  reasons,  —  but  pro- 
vision should  be  made  for  the  maximum  number  that 
may  be  present.  Lighting,  heating,  ventilation,  and 
screening  are  all  important  here  as  in  other  rooms. 
Screening,  particularly,  should  be  carefully  provided, 
and  every  means  employed  to  keep  the  place  free  from 
flies.  The  cleanliness  of  this  room  should  be  as  nearly 
perfect  as  possible,  and  while  it  is  permissible  to  have 
the  room  attractive,  dust-gathering  trappings  should 
be  excluded.  The  mess-tables  are  used  uncovered,  or 
covered  with  white  oil-cloth.  The  former  is  the  prefer- 
able method,  as  it  insures  thorough  cleaning  and  scrub- 
bing, if  the  tables  look  clean.  An  oil-cloth  can  be  made 
to  look  almost  or  quite  its  best  by  a  small  amount  of 
indifferent  rubbing,  though  it  really  may  not  be  free 
from  grease  and  dirt. 

As  said  before,  the  men  should  be  required  to  ob- 
serve the  decencies  at  table,  and  they  are  more  apt  to 
do  so  if  the  decencies  are  observed  toward  them.  The 
table  should  therefore  be  orderly  and  attractive,  though 


60    THE  RECRUIT  AND  HIS  ENVIRONMENT 

plain,  the  dishes  and  utensils  should  be  perfectly  clean 
and  arranged  in  a  proper  manner,  the  food  should  be 
served  in  an  orderly,  attractive,  and  appetizing  way,  and 
with  a  sense  of  fitness.  While  parlor  manners  may  not 
be  expected  in  the  barracks,  gross  indecencies  of  man- 
ner, speech,  or  action  should  be  prevented.  The  room 
and  table  should  be  well  cleaned  after  each  meal,  and 
the  dishes  and  utensils  should  be  carefully  inspected 
daily  and  their  perfect  cleanliness  assured.  Once  a 
week,  or  oftener,  the  tables  and  floors  should  be  thor- 
oughly scrubbed  with  lye  and  water,  and  vinegar-cruets, 
salt-cellars,  mustard-pots,  etc.,  well  washed  and  filled. 
In  warm  weather,  fly-paper  and,  if  necessary,  occasional 
fumigation  with  pyrethrum  fumes,  should  be  used  to 
supplement  the  screens. 

No  man  should  be  allowed  to  eat  with  unclean  hands, 
and  it  should  soon  be  a  matter  of  habit  for  all  men  to 
come  to  the  table  clean  as  to  hands  and  face,  and  neat 
in  appearance.  Leisurely  eating  and  thorough  mastica- 
tion should  be  encouraged. 

After  the  squad-rooms  the  kitchen  is  probably  the 
most  important  room  in  the  barracks.  Its  importance 
has  been  discussed  elsewhere,  but  may  be  emphasized 
here.  It  should  if  practicable  be  a  large  room,  well 
lighted  and  well  ventilated,  opening  on  a  large  porch, 
and  connecting  with  store-rooms  in  the  cellar  or  else- 
where convenient,  and  with  a  roomy  pantry,  with 
abundance  of  shelving  and  drawers,  also  well  lighted 
and  ventilated.  Good  tables,  sinks,  running  water, 
ample  drainage,  sound  and  smooth  meat-block,  an  amply 
large  range,  and  abundance  of  good  kitchen  furniture 
and  utensils  should  be  provided.  A  large  ice-chest  and 
some  screened  shelving  should  be  near  at  hand.   It  is 


THE  HYGIENE  OF  THE  BARRACKS   61 

desirable,  if  practicable,  to  have  a  large  hood  over  the 
range,  to  catch  and  conduct  away,  through  a  ventilating 
shaft,  the  odors,  vapors,  and  smoke  arising  from  the 
cooking.  All  of  these  articles  should  be  frequently  in- 
spected to  make  sure  that  they  are  always  cleaned  as 
soon  as  possible  after  use,  and  never  put  away  in  any 
other  condition.  The  cook,  above  all  men  in  the  com- 
pany, should  live,  think,  and  dream  cleanliness,  and  he 
should  be  held  most  strictly  to  account  for  shortcom- 
ings in  that  line.  The  kitchen  police  should  be  re- 
warded for  efficiency  in  such  a  way  as  to  make  the 
detail  desirable,  and  in  this  way  the  kitchen  should  be 
made  an  object-lesson  and  a  school  of  cleanliness.  The 
inspection  of  the  kitchen  should  include  the  pantry 
and  ice-chest,  should  take  note  of,  and  remedy,  waste  or 
poor  management,  and  should  always  embrace  inquiries 
concerning,  and  search  for,  flies,  roaches,  mice,  and  other 
vermin.  Cats,  dogs,  and  other  pets,  as  well  as  men  not 
tliere  on  duty,  should  be  excluded  at  all  times.  Garbage- 
cans  should  be  outside  of  the  kitchen,  should  be  emptied 
at  least  once  a  day,  and  then  cleaned  inside  and  out ; 
otherwise  they  speedily  become  a  foul  nuisance. 

The  general  remarks  as  to  the  lighting,  heating,  ven- 
tilation, and  cleanliness  apply  to  the  offices  and  the 
shop-rooms  for  the  baker,  tailor,  and  cobbler,  and  the 
inspection  of  these  latter  should  not  be  omitted,  other- 
wise they  are  especially  apt  to  form  accumulations  of 
scraps,  dirt,  and  dust ;  and  they  are  especially  favorable 
distributing  points  for  vermin. 

The  company  barber  should  be  required  to  keep  his 
brushes,  combs,  razors,  and  utensils  thoroughly  clean, 
and  to  sterilize  them  frequently.  He  should  be  obliged 
to  keep  an  abundance  of  clean  towels  and  aprons,  and 


62    THE  RECRUIT  AND  HIS  ENVIRONMENT 

to  be  liberal  in  their  use.  He  is  not  apt  to  be  so  of  his 
own  volition.  He  should  be  instructed  not  to  shave  or 
cut  hair  for  men  with  skin  diseases  without  first  get- 
ting the  surgeon's  assent.  Should  his  own  skin  or  hands 
show  disease,  he  should  consult  the  surgeon. 

Store-rooms  do  not  need  light,  air,  and  heat  in  such 
liberal  amounts  as  do  living-rooms,  but  they  should  be 
dry,  free  from  vermin,  and  should  answer  the  purposes 
for  which  they  are  required. 

Bath-rooms  should  be  well  drained,  well  ventilated, 
and  well  lighted,  and  when  such  is  not  the  case  every 
effort  should  be  made  to  correct  the  condition.  Lighting 
is  facilitated  and  cleanliness  promoted  by  having  walls, 
doors,  and  partitions  painted  white.  Where  tubs  are 
installed,  they  should  be  thoroughly  washed  and  cleaned 
after  each  use,  and  the  floor  should  be  kept  clean  at  all 
times.  Each  man  should  have  his  own  soap  and  towels, 
and  should  take  them  to  and  from  the  tub  with  him. 
When  tubs  are  not  sufficiently  numerous  to  accommo- 
date the  men  as  they  wish  to  go,  they  should  be  detailed 
by  roster  to  bathe,  at  least  once  or  twice  a  week,  and 
as  much  should  always  be  required  of  them.  Shower- 
baths  are  much  more  economical  of  both  time  and  water, 
and  are  installed  at  most  posts.  They,  as  well  as  tubs, 
should  have  both  hot  and  cold  water  connections,  be 
frequently  inspected  as  to  condition,  and  be  kept 
scrupulously  clean.  The  drain  openings  should  not  be 
allowed  to  clog  with  soap  and  hairs,  and  the  entire  bath- 
room should  be  scrubbed  at  least  once  a  week,  and  as 
much  oftener  as  is  necessary  to  keep  it  clean  and  sweet- 
smelling,  and  free  from  mustiness.  Gratings  should  be 
lifted  daily  if  necessary  and  the  space  beneath  flushed 
and  scrubbed.    The  same  general  remarks  apply  to  the 


THE  HYGIENE  OF  THE  BARRACKS        63 

bowls  for  face  and  hand  washing.  The  stoppers  for 
these,  and  the  chains  holding  them,  should  always  be 
clean,  the  outlet  openings  likewise,  and  watch  should 
be  kept  to  prevent  the  formation  of  a  film  or  coat  of 
soap  and  dirt  inside  the  bowls.  The  throwing  of  to- 
bacco, paper,  cotton,  and  dressings  into  bowls,  tubs,  or 
bath  compartments  should  be  forbidden  and  prevented. 
The  man  detailed  in  charge  of  the  bath-room  should  be 
cleanly  and  trustworthy,  and  should  have  authority  to 
enforce  the  rules. 

The  water-closets  are  frequently  in  close  proximity 
to  the  bath-room,  and  if  both  are  kept  clean  there  is  no 
objection  to  it.  Flush-closets  and  urinals  are  installed 
in  practically  all  posts  now,  and  where  such  is  not  the 
case  one  of  the  various  expedients  for  disposing  of  ex- 
creta in  the  field  will  have  to  be  used,  and  reference  is 
made  to  their  description.  Flush-closets  should  be  kept 
clean  at  all  times,  the  bowls  scoured,  and  the  seats 
wiped  off  occasionally  with  a  damp  cloth.  The  floors 
about  them  should  always  be  clean,  and  the  room  should 
be  free  from  odor.  Standing  on  the  seats,  defacing  or 
defiling  them,  throwing  stiff  paper,  matches,  and  other 
things  likely  to  cause  obstruction,  into  the  bowl,  and 
writing  obscenity  on  the  compartment  walls  should  be 
punishable  offenses.  When  a  closet  gets  out  of  order 
in  any  way,  it  should  be  put  out  of  use  until  repaired. 

It  is  to  be  borne  in  mind  that  the  use  of  carbolic  acid 
and  chloride  of  lime  is  but  rarely  necessary  about  flush- 
closets,  and  then  not  for  the  purpose  of  destroying  odors. 

Constant  bad  odors  indicate  lack  of  care  or  poor 
plumbing,  or  both,  and  should  be  corrected.  When 
concealed  by  other  odors,  such  as  those  of  chlorine 
or  carbolic  acid,  they  may  not  be  noticed,  but  the  evil 


64    THE  RECRUIT  AND  HIS  ENVIRONMENT 

condition  of  which  they  gave  warning  is  unremedied. 
Tissue  paper  is  issued  for  toilet  purposes,  and  no  other 
should  be  permitted  to  be  used,  as  being  apt  to  scratch 
or  irritate  the  anus,  and  to  clog  the  drain.  By  signs 
in  the  room,  and  by  verbal  instruction,  the  men  should 
be  taught  to  wash  the  hands  after  every  visit  to  the 
closet.  It  should  also  become  a  habit  for  them  to  inspect 
their  feces  before  flushing  the  closet,  as  disorders  may 
thus  be  brought  to  their  attention,  and  remedies  sought. 
The  passage  of  blood,  pus,  large  amounts  of  mucus,  or 
worms  should  prompt  early  consultation  of  the  surgeon. 
The  closet-rooms  should  be  screened,  and  should  be 
floored  with  cement  to  permit  flushing,  and  to  do  away 
with  cracks  and  crevices.  Roaches  and  flies  should  be 
excluded.  Each  is  indicative  of  unsatisfactory  condi- 
tions. Urinals  are  ordinarily  flush-bowls,  for  use  by 
one  person  at  a  time,  and  should  be  sufficiently  numer- 
ous to  meet  the  demands  of  early  morning  and  of  the 
evening.  The  floor  and  walls  immediately  about  them 
should  be  of  smooth,  hard,  waterproof  material,  such  as 
slate,  and  should  be  washed  thoroughly  each  day  and 
then  lightly  wiped  with  a  moist  rag  sprinkled  with  kero- 
sene. Otherwise  a  crust  of  urinary  salts  is  apt  to  form, 
and  odors  of  decomposing  urine  to  arise.  When  proper 
care  and  cleanliness  are  exercised,  neither  of  these  ap- 
pear, and  the  use  of  deodorants  is  not  necessary.  The 
flushing  of  the  bowls  is  usually  automatic,  and  should  be 
of  sufficient  frequency  to  prevent  deposition  of  salts, 
though  its  action  should  be  supplemented  by  washing 
and  scrubbing  of  the  bowl.  If  the  outlet  of  the  bowl  is 
not  already  screened,  a  piece  of  wire  gauze  should  be 
placed  over  it  and  held  in  place  by  a  small  stone  or 
other  weight,  otherwise  it  may  get  clogged  with  bits  of 


THE  HYGIENE  OF  THE  BARRACKS        65 

cotton,  cigarette-stumps,  and  other  waste  thrown  into 
the  bowl.  The  throwing  of  such  articles  into  urine  bowls 
should  be  punished,  if  detected,  but  detection  is  not 
usual. 

It  is  neither  desirable  nor  practical  to  have  the  men 
do  their  own  laundry- work  in  barracks,  but  a  couple  of 
tubs,  running  water,  and  scrub-brushes  should  be  pro- 
vided, if  possible,  to  enable  them  to  do  a  certain  amount 
of  emergency  work  and  cleaning.  >^ 

The  company  commander  should  familiarize  himself 
with  the  system  of  plumbing  in  his  barracks,  with  a 
view  both  to  detecting  leaks  and  other  faults,  and  to 
taking  action  for  the  institution  of  improvements  where 
indicated,  and  likewise  to  fit  himself  to  distinguish 
between  poor  plumbing  and  inefficient  care  of  good 
plumbing. 

The  water-supply  of  the  barracks  should,  if  possible, 
be  of  water  fit  for  drinking  without  boiling  or  other 
special  preparation.  If  this  is  not  the  case, 
the  men  should  be  warned  and  the  proper 
drinking  supply  carefully  defined  and  lo-  '^^  ^ 

cated.  The  general  supply  should  be  abundant  for  all 
purposes,  and  should  amount  to  one  hundred  gallons  per 
man  per  day,  though  so  much  need  not  ordinarily  be 
used,  and  the  amount  really  used  will  depend  on  a 
number  of  varying  factors,  such  as  temperature  and 
climate,  the  character  of  the  work  done  by  the  men, 
the  care  used,  economy  exercised,  and  the  condition  of 
the  plumbing. 

Where  tub-baths  are  used,  the  consumption  will 
be  greater  than  if  showers  are  used.  While  care 
should  be  exercised  to  prevent  wastP,  it  is  usually 
false  ecopomy  to  Jiiu^er  any  reasonable  use  of  water, 


66    THE  RECRUIT  AND  HIS  ENVIRONMENT 

as  in  bathing,  scrubbing,  watering  plants  or  grass,  or 
laying  dust. 

The  water  should  be  piped  to  the  kitchen,  the  bath- 
rooms, water-closets,  urinals,  wash-basins,  furnace-room, 
and  to  such  places  in  and  about  the  building  as  may  be 
necessary  for  police  purposes  or  fire  protection.  All 
faucets,  exposed  pipes  and  fire-plugs,  and  other  parts 
of  the  water-supply  apparatus,  should  be  frequently  in- 
spected for  leakage  and  as  to  their  working  condition. 

Except  in  the  ways  indicated  above,  the  water-sup- 
ply in  barracks  is  not  usually  controlled  by  the  com- 
pany commander. 

Good  plumbing  presupposes  good  materials,  and  such 
are  usually  furnished.  Iron  pipe  should  conduct  the 
-J.       ,  water-supply,  and  all  joints  should  be  tight. 

.  Faucets  are  usually  of  brass,  and  with  pro- 

per  usage  rarely  need  repairs,  except  new 
washers.  Lead  pipe  is  objectionable  as  being  liable  to 
cause  lead-poisoning.  Some  water  after  a  time  will  cause 
the  pipes  to  fill  partially  or  entirely  with  a  deposit  of 
mineral  salts,  or  a  growth  of  low  vegetable  forms,  with 
a  consequent  lessening  of  the  size  of  the  stream.  Such 
conditions,  as  well  as  advanced  erosion,  may  necessitate 
renewal  of  the  pipe.  Kitchen  sinks  and  wash-bowls 
should  have  their  outlet-pipes  and  traps  exposed  and 
open  to  inspection,  not  closed  in  to  become  musty 
hiding-places  for  roaches.  Kitchen  sinks  are  usually 
made  of  galvanized  or  enameled  iron  or  zinc,  wash- 
bowls of  enameled  iron  or  porcelain.  In  any  event, 
the  surface  should  be  smooth  and  capable  of  complete 
cleaning. 

All  should  be  effectively  trapped  to  prevent  the  re- 
gurgitation of  air  or  gas  from  the  drains.  Sinks  should 


THE  HYGIENE  OF  THE  BARRACKS        67 

preferably  have  grease-traps,  which  should  be  easy  to 
open  and  clean. 

All  bath-tubs  should  be  of  enameled  or  porcelain- 
lined  iron  or  of  zinc,  and  closet  and  urinal  bowls  of 
enameled  iron  or  porcelain.  All  should  be  thoroughly 
trapped,  and  ventilated  on  the  ground  side  of  the  trap, 
by  communicating  with  the  ventilating  pipe.  No  odor 
should  come  from  them,  and  they  should  flush  freely 
and  effectively  on  all  occasions.  Whenever  one  of  them 
is  found  at  all  out  of  order,  flushing  poorly  or  imper- 
fectly, or  emptying  slowly,  it  should  be  put  out  of  use 
until  the  fault  is  corrected.  Such  trouble,  more  often 
than  not,  comes  from  the  use  of  newspaper  as  toilet- 
paper,  or  the  throwing  of  matches  and  other  improper 
objects  into  the  bowls.  Any  leaking  from  a  closet, 
urinal,  or  drain  should  be  immediately  corrected,  as 
especially  apt  to  cause  disease.  The  maintenance  of 
thorough  cleanliness  in  the  closet  is  incidentally  the 
most  ready  way  of  learning  of  such  defects,  while  the 
faults  arising  from  its  neglect  are  at  times  unjustly  at- 
tributed to  the  plumbing. 

Of  the  various  systems  of  lighting  in  use  in  our  bar- 
racks, electricity  is  by  far  the  best.  Both  oil  and  gas 
consume  and  contaminate  the  air,  produce  -  .  ,  ^ 
dirt  and  much  heat,  may  be  blown  out,  and 
give  relatively  poor  light.  Electric  lighting  produces 
no  dirt,  neither  consumes  the  oxygen  nor  adds  to  the 
combustion  products  in  the  rooms,  produces  very  little 
heat,  cannot  be  blown  out,  and  gives  a  brilliant,  steady 
light  that  is  very  much  better  than  either  of  the  others. 
The  danger  of  explosion  is  absent,  and  that  from  fires 
is  reduced  to  a  minimum  by  proper  wiring.  The  lights 
should  be  suf&ciently  numerous  to  illuminate  well  ail 


68    THE  RECRUIT  AND  HIS  ENVIRONMENT 

parts  of  the  building,  while  in  the  reading  and  recrea- 
tion-rooms they  should  be  numerous  enough  and  placed 
low  enough  to  make  reading  and  writing  practically  as 
easy  as  in  the  daytime.  A  particularly  satisfactory 
arrangement  of  electric  lights  is  one  whereby  the  source 
of  light  is  hidden,  the  light  being  reflected  up  to  and 
back  from  a  white  ceiling,  giving  an  even,  steady 
glow  without  glare. ^  Dull  and  flickering  light,  such 
as  is  often  produced  by  gas  or  oil,  is  very  trying  to  the 
eyes,  and  causes  strain  and  fatigue ;  while  the  vitiation 
of  the  air  by  the  combustion  of  these  substances  neces- 
sitates much  more  liberal  ventilation,  or  causes  suffer- 
ing. Economy  in  lighting  should  be  practiced  by  ex- 
tinguishing lights  when  the  necessity  for  their  use  has 
passed,  as  in  the  dining-room  and  kitchen  after  they 
are  cleaned,  in  the  squad-room  late  in  the  evening,  thus 
having  more  for  use  in  recreation-rooms. 

^  "  The  fonr  types  of  lighting  systems  in  common  use  to-day  are  :  day- 
light, direct  lighting  systems,  indirect  lighting  systems,  and  semidirect 
systems.  The  evenness  of  illumination  and  the  proper  diff  useness  of  the 
light,  with  exclusion  of  all  extremes  of  surface  brightness,  are  ideal  con- 
ditions best  realized  at  present  in  the  proper  illumination  of  a  room  by 
daylight.  As  Ferree  points  out,  before  it  reaches  our  windows  or  sky- 
lights, daylight  has  been  rendered  widely  diffuse  by  innumerable  re- 
flections ;  and  the  windows  and  skylights  themselves,  acting  as  sources, 
have  a  broad  area  and  low  intrinsic  brilliancy,  all  of  which  features 
contribute  toward  giving  the  ideal  conditions  of  distribution  stated 
above.  The  best  distribution  effects  given  by  artificial  lighting  are 
obtained  with  the  indirect  systems  in  which  the  source  is  concealed 
from  the  eye  and  the  light  is  thrown  against  the  ceiling  or  some  other 
diffusely  reflecting  surface.  In  the  direct  systems  the  tendency  is  to 
concentrate  the  light  on  the  object  viewed,  and  too  often  the  eye  is 
not  properly  shielded  from  the  source  of  light.  The  semidirect  systems 
represent  a  compromise  in  which  a  part  of  the  light  is  transmitted 
directly  to  the  eye  through  a  translucent  reflector,  and  a  part  reflected 
to  the  ceiling.  Like  most  other  compromises,  this  one  is  not  ideal."  — 
Journal  of  the  American  Medical  Association. 


THE  HYGIENE  OF  THE  BARRACKS   69 

As  stated  earlier,  the  subjects  of  ventilation  and  heat- 
ing are  so  intimately  connected  that  no  consideration 
of  the  one  is  complete  unless  it  includes     _, 
the  other.    This  is  so  for  the  reason  that  ^ 

gravity  is  the  most  important  factor  in  ventilation,  and 
the  weight  of  a  given  volume  of  air  is  less  or  greater  as 
it  is  warm  or  cold.  In  other  words,  we  influence  or  con- 
trol gravity  by  means  of  artificial  heat.  The  same  force 
is  the  principal  factor  concerned  in  the  diffusion  of 
heat  and  heated  air  throughout  barracks. 

In  summer,  doors  and  windows  can  be  kept  open,  and 
ventilation  is  seldom  a  very  serious  problem ;  but  in 
winter  or  very  cold  weather,  when  doors  and  windows 
are  closed  and  all  the  outside  air  is  so  cold  that  its  im- 
pact causes  discomfort,  the  case  is  different. 

Open  fires  are  suitable  for  heating  single,  small 
rooms,  but  not  large  ones,  though  the  presence  of  an 
open-air  fire  aids  in  the  ventilation  of  the  latter  as  well 
as  adds  its  cheer. 

Stoves  give  more  heat  and  less  ventilation,  for  the 
same  amount  of  fuel  used,  than  do  open  fires.  They 
may  be  made  to  promote  ventilation  greatly  by  being 
surrounded  by  a  sheet-iron  cylinder  or  jacket,  into 
which  a  fresh-air  shaft  empties  at  the  bottom.  The 
air  is  warmed  as  it  enters,  and  rises  into  the  room 
through  the  top  of  the  cylinder,  and  later  escapes  by 
way  of  stove-door,  window-cracks,  and  sundry  other 
outlets,  including  outlet-shafts,  if  such  are  provided. 

The  inlet  should  be  screened  to  keep  out  dust  and 
dirt,  and  the  top  of  the  stove  or  of  the  cylinder  should 
always  be  provided  with  an  open  vessel  of  water,  to 
moisten  the  air  by  its  evaporation. 

Cast-iron  stoves  give  off  carbon  monoxide,  a  poison- 


70    THE  RECRUIT  AND  HIS  ENVIRONMENT 

ous  gas,  when  red-hot,  and  may  so  do  harm.  The  air 
used  in  the  combustion  of  fuel  is  taken  from  the  room 
and  passes  up  the  chimney,  fresh  air  replacing  it  from 
the  outside,  and  quite  satisfactory  ventilation  may  at 
times  be  so  maintained,  even  with  unjacketed  stoves, 
but  it  is  not  wise  to  rely  on  such  means  alone,  especially 
in  crowded  barracks.  Slow-burning  stoves,  such  as  an- 
thracite base-burners,  exercise  much  less  influence  in 
this  way  than  rapid-burning  wood  or  soft-coal  stoves. 

Hot-air  furnaces  operate  by  heating  fresh  air,  which 
is  brought  to  them  through  a  ventilating  shaft  from  the 
outside,  and  which,  when  heated,  rises  through  the 
tubes  and  passages  to  the  registers,  whence  it  passes 
into  the  rooms.  One  advantage  of  this  method  of  heat- 
ing is  that,  with  increased  heat,  in  very  cold  weather 
it  sends  up  an  increased  amount  of  fresh  air.  This  air, 
though,  is  usually  very  dry  if  the  water-pan  of  the 
furnace  is  not  carefully  watched  and  kept  filled.  This 
is  due  to  the  fact  that  air  doubles  its  capacity  for  ab- 
sorbing moisture  with  each  increase  of  15°  C.  in  its 
temperature  ;  so  that  outside  air  which  at  zero  C.  does 
not  seem  dry  is  excessively  so  when  raised  to  25°  C. 
For  this  reason  all  systems  of  artificial  heating  should 
make  some  provision  for  moistening  the  heated  air ; 
which  otherwise  causes  discomfort  and  harm. 

The  method  of  heating  just  described  is  not  very  much 
used  in  our  barracks,  being  regarded  less  favorably 
than  the  steam  and  hot-water  systems. 

Steam-heating  is  very  satisfactory  and  is  much  used. 
In  this  system  the  heat  from  the  fire  is  transmitted 
to  water,  which  is  made  to  boil,  under  pressure  if  neces- 
sary, and  the  heat  is  carried  throughout  the  building 
by  the  steam,  which  travels  through  tight  iron  pipes 


THE  HYGIENE  OF  THE  BARRACKS        71 

that  expand  into  radiators  in  the  various  rooms.  It  is 
a  rapid  method  of  heating,  and  one  easily  controlled  by 
an  intelligent  man,  and  such  a  man  should  be  detailed 
in  charge  of  it.  He  should  maintain  an  even,  steady 
fire,  enough  steam  to  make  the  rooms  comfortable,  and 
keep  the  water  in  the  boilers  at  a  constant  and  proper 
level.  Such  plants  usually  show  their  maximum  effi- 
ciency when  a  steam  pressure  of  one  or  two  pounds  is 
maintained. 

Water  should  be  kept  evaporating  from  the  radi- 
ators, or,  with  a  good  man  in  charge  of  the  system, 
steam  may  be  allowed  to  escape  from  them  to  moisten 
the  air. 

Hot-water  Keating  is  somewhat  similar,  but  the  pipes 
are  filled  with  water  instead  of  steam.  It  is  a  very  steady 
method  of  heating,  but  slower  in  either  heating  or  cool- 
ing than  steam.  High  and  low  pressure  systems  are 
used,  only  the  latter  in  our  service. 

The  air  heated  by  the  radiators  is  dried  thereby,  and 
provision  should  be  made  for  moistening  it. 

When  steam  and  hot-water  heating  are  used,  they  are 
made  to  promote  ventilation  by  having  the  fresh  air 
enter  the  rooms  through  or  under  the  radiators.  It  is 
thereby  warmed  and  made  lighter,  and  at  once  rises,  to 
be  later  distributed  through  the  room  by  gravity,  con- 
vection, and  diffusion.  In  order  that  it  may  not  again  be 
drawn  through  the  radiators  and  redistributed,  a  line  of 
less  resistance  should  be  created  for  it  by  ventilating 
shafts  opening  near  the  floor  and  leading  to  the  roof,  or 
by  an  open  fire-place  to  answer  the  same  purpose. 

As  there  is  also  danger  of  fire  in  and  about  barracks, 
and  as  that  danger  is  increased  in  cold  weather,  all 
chimneys,  flues,  shafts,  stoves,  furnaces,  etc.,  should  be 


72    THE  RECRUIT  AND  HIS  ENVIRONMENT 

thoroughly  inspected  and  put  into  first-class  condition 
in  the  late  summer  or  early  fall,  before  fires  are  started. 
Competent  men  only  should  be  detailed  in  charge  of 
fires,  fire-drill  should  be  held  sufficiently  often  to  famil- 
iarize the  men  with  their  duties  in  case  of  conflagration, 
and  fire-buckets  filled  with  water  should  be  distributed 
about  the  buildings.  As  a  matter  of  cleanliness,  and  still 
more  as  a  matter  of  hygiene,  and  especially  in  the  trop- 
ics, this  water  should  be  renewed  once  or  twice  weekly, 
to  prevent  its  serving  as  a  breeding-place  for  mosqui- 
toes. Frequent  inspections  should  verify  the  thorough- 
ness and  effectiveness  of  this  measure. 

The  avoidance  of  mosquitoes,  flies,  roaches,  lice,  and 

other  vermin  has  already  been  shown  to  be  principally 

.  a  matter  of  screening,  cleanliness,  and  po- 

lice  ;  but  if  an  old  barracks  is  infested  with 

bed-buffS  or  fleas,  it  is  often  a  most  difficult  matter  to 

get  rid  of  them. 

The  most  effective  way  to  do  so  is  to  give  the  build- 
ing and  furniture  a  thorough  overhauling,  scalding  out 
cracks  and  crannies  of  beds,  floors,  and  walls,  with  boil- 
ing water,  washing  them  with  jive  per  cent  carbolic 
solution,  then  closing  all  cracks  with  putty  or  strips  of 
board,  and  painting  over  all.  Infested  clothing  or  bed- 
ding should  be  washed  or  steamed. 

Frequent  inspections  should  be  made  for  the  early 
detection  of  any  recurrence  or  reintroduction  of  the 
pests,  when  their  eradication  from  one  room,  or  even 
from  one  bed,  may  suffice  to  end  the  trouble. 


CHAPTER  V 

CAMPS 

The  soldier's  time  is  partly  spent  in  camps,  and  occa* 
sionally  the  periods  so  spent  may  extend  to  many  months. 
The  conditions  of  camp-life  are  in  many  respects  radi- 
cally different  from  those  in  barracks  ;  the  old  sanitary 
problems  may  have  to  be  met  in  very  different  ways, 
while  new  ones  arise,  and  sickness  once  started  has 
opportunities  to  spread  that  differ  somewhat  from  those 
in  barracks.  Our  own  unfortunate  experiences  in  the 
camps  of  concentration  in  1898  clearly  show  that  the 
assemblage  of  large  bodies  of  raw  troops  into  great 
camps  is  in  itself  a  dangerous  matter,  and  that,  if  wise 
care  founded  on  knowledge  is  not  used  to  prevent  it, 
diseases  in  epidemic  form  may  create  greater  havoc 
than  the  enemy  in  arms.  On  the  other  hand,  the  ex- 
cellent sanitary  and  health  conditions  maintained  for 
long  periods  in  the  camps  on  the  Mexican  border,  as 
well  as  in  numerous  other  camps  of  the  last  few  years, 
show  clearly  that  the  intelligent  and  earnest  application 
of  our  present  knowledge  suffices  to  prevent  such  con- 
ditions in  time  of  peace.  Whether  or  not  the  knowledge 
we  have  can  be  effectively  applied  on  the  vast  battle- 
fields of  Europe  is  now  in  process  of  demonstration. 

The  medical  department  must  and  does  take  the  in- 
itiative in  sanitary  matters,  and  it  naturally  finds  much 
satisfaction  in  the  excellent  recent  results,  but  it  is  only 
by  having  the  interested  and  intelligent  cooperation  of 
the  line  that  such  results  are  attainable. 


74    THE  RECRUIT    AND  HIS  ENVIRONMENT 

At  times  the  choice  of  the  camp-site  will  devolve  upon 
the  company  commander,  at  other  times  a  site  is  assigned 
_  to  him  by  higher  authority,  and  he  has  no 

choice  in  the  matter.  It  is,  however,  usually 
within  his  power  to  improve  a  poor  site,  or  to  impair 
or  destroy  the  value  of  a  good  one  ;  and  whether  he  is 
more  likely  to  do  the  one  thing  or  the  other  depends 
largely  upon  his  knowledge  of  military  hygiene.  The 
general  principles  regarding  the  selection,  arrangement, 
and  care  of  camps,  as  laid  down  in  the  Field  Service 
Regulations,  are  to  be  observed,  though  they  can  at 
times  be  improved  upon,  and  when  such  is  the  case  it 
should  be  done.  Let  it  be  remembered  that  from  a 
sanitary  standpoint  the  important  desiderata  are:  first, 
that  the  site  should  be  clean  and  healthful ;  second, 
that  it  should  be  kept  clean  and  free  from  infection 
during  its  occupancy ;  third,  that  it  should  be  left  so 
after  the  departure  of  the  troops. 

The  consideration  of  the  site  of  a  camp  must  include 
an  investigation  of  the  healthfulness  of  the  surrounding 
country,  and  in  certain  instances  a  very  desirable  site  is 
wisely  abandoned  for  one  apparently  less  so,  because  the 
health  conditions  may  be  known  to  be  better  in  the  lat- 
ter. For  example,  in  the  Bitter  Root  valley  in  western 
Montana  there  occurs  during  the  spring  months  a  fatal 
fever,  which  is  conveyed  by  the  bites  of  infected  ticks. 
These  are  found  principally  on  the  west  bank  of  the 
stream,  the  eastern  side  being  almost  free  from  the 
disease.  It  would  be  wise,  in  that  territory  and  at  such 
a  season,  to  forego  considerable  advantages  that  might 
be  found  on  the  western  side,  and  to  take  the  trouble  of 
crossing  the  stream,  rather  than  to  rim  the  greater  risk 
of  infection  with  the  "  tick  fever."  A  somewhat  similar 


CAMPS  75 

disease  occurs  in  certain  river-bottoms  in  Japan,  and 
in  that  case  the  camp  could  be  safely  placed  on  the 
infected  side  of  the  stream,  above  all  levels  sulked  to 
fioodinrj^  as  the  infected  insects  are  met  with  only  at 
such  levels.  Oroya  fever  occurs  only  in  certain  narrow 
Andean  valleys  high  above  sea  level.  Kala-azar  is 
found  especially  in  old  and  infected  coolie  lines  and 
houses,  and  in  Africa  sleeping  sickness  is  transmitted 
by  a  fly  that  is  found  only  in  or  about  thick  underbrush 
close  to  water,  and  relapsing  fever  by  infected  ticks  that 
appear  principally  in  regular  rest-places  or  camps. 

The  qualities  desirable  in  a  camp-site  vary  somewhat 
with  the  season,  breeze  and  shade,  for  instance,  being 
desirable  in  summer  and  undesirable  in  winter.  The  site 
should  have  a  natural  slope,  to  insure  the  speedy  disap- 
pearance of  rain-water  from  tents  and  streets.  The  sur- 
face should  be  as  regular  and  smooth  as  can  be  obtained, 
free  from  numerous  rocks  and  hollows.  Stumps  and 
trees  are  at  times  objectionable,  particularly  if  numerous 
and  close  set,  but  at  other  times  they  can  be  put  to  a 
surprising  number  of  uses,  and  those  that  are  most  in 
the  way  will  disappear  in  a  short  time  after  the  camp  is 
made.  The  inequalities  of  surface  due  to  numerous  large 
roots  or  lightly  covered  rocks  are,  however,  harder  to 
overcome. 

The  soil  of  the  camp-site  should  be  dry  and  firm,  so 
as  not  to  give  rise  to  a  great  amount  of  dust  in  dry,  or 
mud  in  wet,  weather.  Sandy  or  very  soft  loam  is 
undesirable,  and,  in  very  windy  seasons  or  neighbor- 
hoods, the  dust  it  gives  rise  to  may  be  a  plague.  A 
surface  well  set  with  grass  is  good,  if  not  damp  ;  but 
the  grass  will  soon  die  in  tents  and  be  tram}^>ed  to 
pieces  in  the  streets,  and  should  be  well  cleaned  up. 


76    THE  RECRUIT  AND  HIS  ENVIRONMENT 

The  neighborhood  of  marshes  or  standing  water  should, 
if  possible,  be  avoided,  principally  because  they  are 
apt  to  be  infested  with  mosquitoes,  but  also  because 
the  ground  may  be  wet.  Ordinarily,  high-ground 
water  (shown  by  its  nearness  to  the  surface  in  wells 
or  pits)  makes  for  insalubrious  conditions,  much  as 
do  marshes. 

Winds  may  be  desirable  or  the  reverse,  according  to 
circumstances.  In  regions  where  mosquitoes  are  abun- 
dant, a  prevailing  wind  blowing  them  away  from  the 
camp  is  a  great  comfort,  one  in  the  opposite  direction 
a  great  nuisance.  However,  certain  observations  in  the 
Canal  Zone  have  led  excellent  observers  to  believe  that 
mosquitoes,  especially  certain  species  oi  Anopheles,  may 
and  do  fly  considerable  distances,  even  up  to  a  mile  or 
more,  against  the  wind  to  get  to  towns  and  camps,  ap- 
parently attracted  by  the  odor. 

In  wintry  weather  a  strong  wind  always  produces 
discomfort,  and  in  summer  it  may  do  so  because  of  the 
dust  and  dirt  it  blows,  and  in  such  circumstances  shelter 
from  it  should  be  sought. 

As  sites  are  unhealthful  or  infected,  in  most  in- 
stances, either  because  of  the  presence  of  disease-carry- 
ing and  infected  insects,  such  as  mosquitoes  or  ticks, 
or  because  of  their  previous  infection  from  human  oc- 
cupancy, old  camps,  marshy  grounds,  and  places  apt 
to  present  the  conditions  mentioned,  should  be  avoided. 
While  the  avoidance  of  malarious  swamps  and  of  such 
disease-centres  as  have  been  mentioned  above  is  of  the 
greatest  importance  in  regard  to  certain  diseases,  espe- 
cially those  that  are  insect-borne,  it  is  usually  camp 
diarrhoea,  dysentery,  typhoid,  and  other  infections  dis- 
seminated largely   by  man    himself  that  create   the 


CAMPS  77 

greatest  havoc  in  camps.  The  danger  from  these  usu- 
ally increases  with  the  length  of  time  the  camps  are 
occupied,  and  with  the  increased  opportunity  for  their 
defilement.  This  being  so,  bivouacs,  temporary  and  per- 
manent camps  are  apt  to  be  defiled  in  an  increasingly 
dangerous  degree  in  the  order  named.  Even  a  dirty 
bivouac-ground  may  constitute  a  menace  to  the  inhab- 
itants of  the  region,  to  other  troops  later  following  the 
same  route,  or  to  the  command  leaving  it,  on  its  return 
that  way. 

The  danger  of  infectious  diseases  is  lessened  by  at- 
tention to  the  following  points  :  — 

The  ordinary  shelter  of  the  camp  is  furnished  by 
tents,  which  may  be  of  any  of  the  varieties  issued  for 
the  service,  though  the  shelter-tent  is  only  _ 
exceptionally  used,  in  one  camp,  for  more 
than  a  few  days  at  a  time.  All  tents  are  apt  to  be  hot 
in  summer  and  cold  in  winter,  objections  partly  met 
by  the  proper  use  of  tent-flies.  All  are  liable  to  be 
crowded,  and  the  air  to  contain  many  micro-organisms 
when  they  are  kept  closed.  This  can  be  met  by  thor- 
ough sunning  and  ventilation,  with  walls  raised,  for  a 
part  of  each  day  when  the  weather  permits,  and  by  the 
frequent  removal,  cleaning,  and  airing  of  all  blankets, 
clothing,  and  accoutrements  to  which  the  moulds  and 
other  organisms  adhere,  and  the  exclusion  of  articles 
in  or  on  which  they  may  grow,  such  as  food,  dirty 
straw,  trampled  grass,  empty  but  unclean  bottles,  cans, 
and  boxes.  All  tents  are  apt  to  be  damp  in  rainy  or 
wet  weather,  and  to  lessen  this  they  should  be  well 
ditched,  so  that  all  water  from  the  tent-walls  and  the 
surrounding  ground  is  carried  away  and  the  tent-floor 
kept  dry.    If  the  camp  is  to  be  occupied  for  any  con- 


78    THE  RECRUIT  AND  HIS  ENVIRONMENT 

siderable  length  of  time,  board  floors  should  be  fur- 
nished, or  the  interior  be  filled  with  fine  gravel  and 
rammed,  while  company  streets  should  be  raised  and 
made  hard  and  smooth  by  pounding  or  rolling;  they 
can  be  much  improved  by  sprinkling  and  treatment 
with  crude  oil,  especially  an  oil  that  contains  a  large 
amount  of  asphalt  base,  as  most  California  oil  does. 
.If  floors  are  used,  they  should  be  raised  occasionally 
and  the  space  beneath  thoroughly  cleaned  and  aired.  The 
general  tent  ventilation  is  also  important  in  promoting 
dryness.  Because  of  the  dampness,  men  should  always 
try  to  sleep  off  of  the  ground.  In  permanent  camps  they 
may  have  cots.  Straw  sacks  are  helpful,  but  they  also 
should  be  raised  if  practicable.  Cots  or  beds  may  be 
improvised  from  timber,  or  easily  from  bamboo,  in  a 
country  where  that  abounds.  Small  branches  of  pine  or 
other  evergreen  boughs  serve  to  make  a  well-ventilated 
and  comfortable  bed  where  they  are  found.  Boughs, 
cornstalks,  loose  straw,  moss  or  dry  leaves  may  be  avail- 
able in  bivouacs.  In  other  camps  than  bivouacs  these 
materials  should  be  stirred  up  and  aired  daily  and 
renewed  before  they  become  mouldy  or  much  broken  up. 
Owing  to  the  crowding  in  camps  and  the  frequently 
poor  bathing  facilities,  the  opportunities  for  the  spread 
of  body- verm  in  are  unusually  good,  and  all  precau- 
tions as  to  cleanliness,  clothes-washing,  and  steriliza- 
tion, if  necessary,  should  be  exercised  to  prevent  their 
introduction  and  dissemination.  Dogs,  cats,  and  other 
pets  should  be  excluded  from  tents  and  usually  from 
camps.  Mosquitoes  are  to  be  avoided  by  means  to  be 
considered  later,  but  if  they  are  present,  nets  must 
be  used.  Flies,  roaches,  rats,  and  mice  are  best  kept 
down  by  the  maintenance  of  such  good  police  that  they 


CAMPS  79 

find  no  breeding-places,  and  no  access  to  food  in  or 
about  the  tents ;  hence  the  exclusion  of  food,  boxes, 
cans,  etc.  In  some  places  the  camp  is  very  apt  to  be  full 
of  fleas,  and,  as  these  insects  do  not  stay  long  on  their 
hosts  and  breed  in  the  sand,  floors,  or  bedding,  cleanli- 
ness of  tents,  floors,  and  surroundings  is  most  impor- 
tant, as  the  young  live  on  decomposing  animal  and 
vegetable  matters  found  there. 

Because  of  ignorance,  laziness,  or  viciousness,  men  at 
times  urinate  in  or  near  tents  instead  of  seeking  urinals. 
The  offense  may  not  be  readily  detected,  but  it  is  none 
the  less  filthy  and  dangerous,  and  should  be  severely 
punished  when  detected. 

Huts^  cabins,  and  dugouts  may  be  used  instead  of 
tents  in  long-established  camps,  particularly  in  cold 
climates  or  seasons.  Because  they  are  not  so  accessible 
to  light,  ventilation,  or  cleaning  as  are  tents,  even  closer 
and  more  frequent  inspections  and  greater  care  in  clean- 
ing are  necessary,  and  particularly  so  in  the  prevention 
or  elimination  of  vermin.  At  least  once  a  week  all 
clothing,  bedding,  accoutrements,  and  other  accumula- 
tions of  personal  belongings  should  be  moved  outside 
and  the  places  thoroughly  inspected  and  cleaned.  Such 
places  as  well  as  tents  will  require  heating  in  cold 
weather,  but  as  long  as  proper  precautions  are  taken 
against  fire  and  to  provide  for  the  escape  of  combustion 
products,  this  is  desirable,  as  promoting  dryness  and 
ventilation,  as  well  as  comfort.  Dryness  of  shelters  and 
abundance  of  fresh  air  should  be  assured  by  all  possible 
means,  and  to  every  man.  All  should  work  out-of-doors 
a  part  of  each  day.  Wet  clothes  should  be  dried  and 
dirty  ones  washed  outside  of  the  shelter,  if  it  be  at  all 
practicable.  Men  with  clothing  or  shoes  wet  from  rain, 


80    THE  RECRUIT  AND  HIS  ENVIRONMENT 

snow,  or  slush  should  change  them  for  dry  at  the  first 
opportunity,  and  before  lying  down  to  rest  or  sleep.  So 
far  as  military  necessities  permit,  men,  even  those  on 
guard,  should  be  allowed  to  shelter  themselves  from 
inclemencies  of  the  weather. 

The  water-supply  to  permanent  or  semi-permanent 
camps  may  be  piped  throughout  them  and  delivered 
__  from  stand-pipes  conveniently  placed.    In 

other  instances,  it  will  have  to  be  hauled  or 
carried  from  wells,  cisterns,  streams,  and  other  sources 
of  supply,  to  the  place  of  consumption.  If  it  is  known 
to  be  good  and  free  from  infection,  it  may  be  drunk  as 
delivered ;  but  when  doubt  exists  as  to  its  purity,  and 
such  will  most  often  be  the  case,  it  must  be  boiled  or 
filtered  before  use.  Boiling  destroys  all  disease-produc- 
ing organisms  that  are  found  in  water,  and  renders 
it  safe.  Prolonged  boiling  makes  assurance  doubly 
sure,  but  if  fuel  or  time  is  precious,  making  certain 
that  the  water  comes  to  the  boiling-point  once  may 
suffice,  as  that  will  destroy  the  organisms  of  typhoid, 
cholera,  and  dysentery.  But  it  is  at  best  a  time-con- 
suming process,  and  if  the  water  is  not  well  cooled  it  is 
not  so  refreshing,  and  men  seek  it  from  other  sources. 
Other  methods  of  purification  are  therefore  resorted 
to,  and  among  these  are  filtration  and  treatment  with 
chemicals.  The  Darnall  filter,  the  efficacy  of  which  de- 
pends largely  on  the  precipitation  of  suspended  matters 
before  the  filtration,  and  filters  of  the  Berkefeld  or 
Chamberland  types,  that  are  efficient  by  virtue  of  the 
fineness  of  their  pores,  are  of  great  value,  though  the 
former  type  shows  erratic  action  at  times  and  the  others 
are  apt  to  be  broken  or  get  out  of  order  on  field  service. 

Chemical   treatment  of  suspected  or  contaminated 


CAMPS  81 

waters  is  now  used  by  many  large  cities,  and  gives  very 
good  results.  In  its  simplest  form,  in  a  camp,  it  would 
ordinarily  consist  in  adding  one  part  of  "  chloride  of 
lime  "  to  about  600,000  parts  of  the  water.  For  small 
quantities  of  water  this  may  be  measured  as  follows : 
Take  a  level  teaspoonf ul  of  chloride  of  lime  and  dis- 
solve it  in  four  pints  of  water.  Of  this  add  one  tea- 
spoonful  to  a  gallon  of  the  water  to  be  purified,  or  one 
tablespoonful  to  four  gallons,  or  ten  tablespoonf uls  to 
a  barrel  of  water,  and  allow  it  to  stand  for  at  least  half 
an  hour  before  use.  The  ordinary  amount  used  by  city 
water  purification  plants  is  one  part  to  a  million,  or  even 
less,  but  one  part  in  half  a  million  does  not  affect  the 
taste  or  smell  of  water,  is  harmless,  and  is  necessary  in 
water  containing  much  organic  matter,  so  that  the  use 
of  that  strength  or  double  it  is  advised  for  the  field.  ^ 

However  purified,  the  drinking  water  should  be  kept 
pure  and  protected  from  all  sorts  of  contamination  until 
used.  This  is  provided  for  in  the  directions  accompany- 
ing the  Darnall  filter,  but  special  arrangement  has  to  be 
made  in  other  cases.  A  simple  and  effective  way  of  doing 
it  is  to  have  one  drinking-place  for  each  company,  and 
to  have  at  that  place  two  or  three  barrels  or  large  cans 
fitted  with  covers  and  with  faucets  near  the  bottoms. 
Water  should  be  boiled,  or  otherwise  purified,  and  run 
into  one  of  these,  covered,  and  allowed  to  cool.  When 
cool  it  is  marked  as  ready  for  use,  and  the  water  is  drawn 
off  through  the  faucet  as  needed.  Meanwhile  the  next 
canful  is  cooling.  When  the  first  can  is  emptied,  it  is 
rinsed  out  with  boiling  water  and  refilled,  to  cool  while 

^  Should  one  have  occasion  to  install  a  simple  and  cheap  chlorine 
purification  plant  at  a  post,  a  good  description  of  one  may  be  found  in 
U.  S.  Public  Health  Report,  October  9,  1914. 


82    THE  RECRUIT  AND  HIS  ENVIRONMENT 

the  second  is  in  use,  and  so  on.  The  barrels  or  cans 
should  be  elevated  on  a  platform  so  that  the  faucet 
may  be  convenient,  and  a  soakage-pit  should  be  dug  be- 
neath the  drip  and  filled  with  small  stones  or  gravel 
to  prevent  the  formation  of  a  mud-puddle.  Waste  of 
the  water  should  be  discouraged,  but  if  it  amounts  to 
more  than  can  be  cared  for  by  the  pit,  which  should  be 
about  one  foot  deep  by  two  to  three  feet  square,  outlets 
a  foot  wide  and  six  inches  deep,  and  of  such  length  as 
necessary,  may  be  made  and  filled  with  stones  or  gravel, 
to  lead  away  the  excess  and  permit  of  its  absorption. 

Outside  contamination  is  prevented  by  the  use  of 
the  tight-fitting  cover.  If  faucets  are  not  to  be  had, 
siphons  may  be  improvised,  if  rubber-tubing  is  avail- 
able. Otherwise,  the  water  will  have  to  be  dipped.  If 
so,  a  clean  dipper  should  be  provided  for  the  purpose, 
and  the  water  emptied  from  it  into  the  drinking  ves- 
sels. No  cup  should  be  dipped  in  the  water  after  it 
has  been  contaminated  by  hands  or  mouth.  The  dipper 
should  be  scalded  from  time  to  time,  and  should  be 
kept  clean  in  every  way.  If  reliably  clean  ice  is  obtain- 
able, it  may  be  added  to  the  water.  If  its  quality  is 
doubtful,  it  may  be  packed  around  vessels  of  water, 
but  should  not  be  put  into  them.  The  general  care  of 
the  water-supply  as  prescribed  in  Field  Service  Regula- 
tions should  be  observed. 

There  are  no  tests  that  can  be  quickly  applied  that 
will  enable  a  medical  officer  to  pronounce  a  given 
water-supply  safe.  He  may  form  an  opinion  to  that 
effect  from  a  consideration  of  the  source  and  surround- 
ings of  the  supply,  but  any  idea  that  he  can,  by  a 
simple  and  quick  chemical  test,  or  a  microscopic  ex- 
amination of  it,  gain  positive  knowledge  that  it  is  pure 


CAMPS  83 

and  safe  is  fallacious,  and  should  not  be  entertained. 
If  the  supply  probably  receives  seepage  from  privies, 
stables,  or  homes,  or  washings  from  the  same,  or  drain- 
age from  near-by  cities  or  towns,  it  must  be  regarded 
as  unsafe ;  and  in  other  cases,  where  sources  of  con- 
tamination are  not  so  evident,  it  is  wisely  precaution- 
ary to  take  the  same  view.  In  fixed  camps  there  may 
be  opportunities  for  the  full  and  careful  examination 
of  water-supplies  ;  but  even  when  such  is  the  case,  and 
the  water  is  found  satisfactory,  the  condition  may 
change  in  a  day  because  of  some  accident  or  the  care- 
lessness of  one  or  a  few  men.  Boiled  water  should 
be  used  for  many  kitchen  purposes,  such  as  washing 
food-receptacles  and  such  foods  as  are  eaten  raw.  Boiled 
or  actually  boiling  water  should  be  furnished  the  men 
for  washing  their  mess-kits.  A  good  arrangement  is  to 
have  for  each  company  a  box,  a  row  of  large  kettles  of 
hot  water,  at  least  one  of  them  actually  boiling,  and 
a  small  mop  or  scrub-Jbrush.  As  a  man  finishes  a 
meal,  he  takes  his  mess-pan  and  implements  to  the 
place  where  these  are,  scrapes  any  food-remnants  into 
the  box,  rinses  the  articles  clean  in  the  first  kettle, 
passes  to  the  second  and  there  scrubs  them  with  the 
brush,  and  then  scalds  them  in  the  boiling  water  of  the 
third  kettle.  Proper  provision  should  be  made,  by 
means  of  a  trough-container  or  otherwise,  to  prevent 
soiling  of  the  ground  with  bits  of  food  or  greasy  water. 
The  water-supply  should  be  sufficient  to  provide 
baths  for  the  men.  If  the  camp  be  situated  on  a  stream 
or  other  body  of  water,  it  may  afford  proper  . 

facilities  in  warm  weather.  Where  such  is  ° 

not  the  case,  and  in  cold  weather,  special  provision  will 
need  to  be  made.    Such  provision  will  include  a  proper 


84    THE  RECRUIT  AND  HIS  ENVIRONMENT 

supply  of  water,  sheltered  and  warm  bathing-places, 
and  a  proper  disposal  of  the  dirty  water. 

The  supply  of  water  may  be  piped  to  the  bathing- 
place,  or  it  may  have  to  be  carried  there.  The  former 
condition  need  not,  ordinarily,  concern  the  company 
officer,  except  that,  if  the  water  as  delivered  is  very 
cold,  most  of  his  men  will  not  bathe  in  it  in  cold 
weather.  In  case  it  has  to  be  carried,  each  man  should 
carry  for  his  own  use,  and  economy  will  then  be  exer- 
cised. The  most  effective  use  is  then  made  of  the 
water  if  the  bather  first  scrubs  himself  from  a  basin, 
usiug  soap  and  a  rough  cloth,  and  later  rinses  off  the 
soap  with  a  shower,  which  may  be  improvised  by 
means  of  a  large  tin  can  and  a  piece  of  rope.  Warm 
water  should  always  be  available,  and  may  be  kept  so 
if  a  large  can  of  water  be  kept  over  a  fire  near  the 
bathing-place,  and  any  man  desiring  to  bathe  be  al- 
lowed to  take  from  it,  replacing  an  equal  amount  of 
cold  water.  A  sheltered  and  warm  bathing-place  may 
consist  of  a  room  in  a  convenient  building,  of  a  special 
house,  shed,  or  tent,  heated,  if  necessary,  by  a  stove,  an 
extemporized  brick  oven,  or  other  means.  The  floor 
should  be  hard  and  dry,  or  should  be  covered  with 
wooden  gratings  to  lift  one  above  the  waste  water.  If 
for  lack  of  time  or  other  reason  a  suitable  bathing- 
place  has  not  been  prepared,  and  if  it  be  cold  weather, 
hot  water  may  be  furnished  and  men  allowed  to  take 
baths  in  their  tents.  In  such  cases  they  should  be 
careful  not  to  spill  water. 

If  bathing  is  possible  only  at  the  cost  of  considerable 
labor  or  inconvenience,  a  proportion  of  the  men  will 
neglect  it,  and  it  is  therefore  desirable  that  a  proper 
place  be  provided  and  the  men  required  to  bathe  at 


CAMPS  85 

least  once  a  week ;  while  the  feet,  face,  and  hands  should 
be  bathed  oftener,  and  facilities  should  be  provided  for 
that.  These  may  be  just  outside  or  inside  the  tents. 
The  disposal  of  waste  water  is  at  times  as  great  a 
problem  as  the  procuring  of  the  fresh  supply,  and  it 
will  have  to  be  solved  in  different  ways  under  different 
circumstances.  In  large  or  permanent  camps  under- 
ground drains  may  lead  it  away ;  at  other  times  trenches 
may  conduct  it  to  a  near-by  stream  or  to  dry  wells  or 
pits,  and  occasionally  it  may  be  necessary  to  collect  it 
in  barrels  and  haul  it  away.  Always,  care  should  be 
exercised  that  it  does  not  flow  or  soak  to  the  source  of 
supply  and  contaminate  that,  and  that  it  does  not  form 
breeding-places  for  mosquitoes.  Where  other  provision 
is  not  made,  fairly  satisfactory  results  may  usually  be 
obtained  as  follows:  A  suitable  space  inside  of  a  tent, 
say  five  or  six  feet  square,  is  dug  to  a  depth  of  four 
inches,  and  filled  with  gravel  or  fine  stone,  which  is 
rammed.  Over  this  a  wooden  grating  is  placed,  and 
on  the  grating  the  men  bathe.  From  the  lower  side  of 
the  space,  trenches  four  inches  deep  and  a  foot  wide  are 
dug  and  filled  with  gravel  or  stones,  and  they  conduct 
the  water  downhill  to  an  open  trench  that  leads  it 
away,  or  to  a  soakage-pit  about  a  yard  square  and 
deep,  or  larger  if  necessary,  that  is  filled  with  large 
rocks,  whence  it  soaks  into  the  ground.  Such  pits,  if 
in  porous  soil  or  gravel,  will  dispose  of  a  great  amount 
of  water  in  a  day.  If  in  clay  or  close-grained  soil,  their 
working  is  not  so  satisfactory,  and  it  may  do  better  to 
run  the  water  out  in  numerous,  shallow  surface-trenches 
from  which  it  can  evaporate.  Similar  precautions  may 
be  taken  to  provide  for  the  waste  water  from  drinking- 
troughs  for  animals. 


86    THE  RECRUIT  AND  HIS  ENVIRONMENT 

Facilities  for  washing  clothing  should  be  provided 
in  each  company,  though  they  need  not  be  more  elabo- 
rate than  a  supply  of  good,  and  preferably  warm,  water, 
a  board,  and  a  scrubbing-brush  and  soap,  The  waste 
water  may  be  disposed  of  as  indicated  for  bath-water. 
If  a  boiler  can  be  provided  for  clothes,  it  is  desirable 
to  have  it.  In  rainy  weather  a  heated  tent  should  be 
furnished  in  which  to  dry  them,  but  at  most  times  they 
can  dry  in  the  open. 

As  in  barracks,  so  in  camp,  the  kitchen  is  one  of  the 
most  important  parts  of  the  command,  and  on  its  proper 
administration  depends  much  of  the  cheer- 
fulness, health,  and  efficiency  of  the  men. 
The  food  should  be  abundant  and  good,  and  its  prepa- 
ration such  that  the  men  will  be  nourished  and  satisfied 
by  it,  and  not  under  the  temptation  to  gorge  themselves 
with  pies,  milk,  and  soft  drinks  of  doubtful  character 
from  outside  sources. 

The  mess  in  fixed  camps  may  be  made  quite  as  good 
as  in  barracks,  and,  except  in  rare  emergencies,  the 
articles  of  the  ration  are  both  good  and  abundant.  As 
the  problem  of  cooking  is  presented  somewhat  dif- 
ferently in  the  field  and  in  barracks,  the  company  com- 
mander, the  mess-sergeant,  and  the  cooks  should  all  study 
the  best  methods  for  field  service.  Some  excellent  gar- 
rison cooks  are  not  nearly  so  good  in  the  field,  while 
others  excel  there.  Economy,  good  management,  and 
cleanliness  are  as  important  in  the  field  as  elsewhere, 
while,  owing  to  the  outdoor  life  and  active  exercise,  the 
appetite  is  usually  increased  and  more  food  required. 
Owing  to  the  liability  of  chilling,  exposure  to  wet, 
and  the  greater  opportunities  for  intestinal  infection, 
irritating,  indigestible,  and  slightly  nourishing  foods, 


CAMPS  87 

such  as  green  corn  and  boiled  cabbage,  should  be  used 
sparingly,  while  green  or  overripe  fruits  should  be  for- 
bidden. In  the  presence  of  epidemics  of  intestinal 
diseases,  it  makes  for  safety  if  only  cooked  food  is 
eaten.  Underdone  cereals  or  vegetables  are  apt  to  cause 
indigestion,  and  as  they  are  more  difficult  to  cook 
thoroughly  in  the  field  because  of  the  trouble  with 
fires,  wind,  etc.,  particular  attention  should  be  paid  to 
them.  Rice,  beans,  hominy,  oatmeal,  and  potatoes  are 
probably  most  apt  to  be  underdone.  The  methods  of 
cooking  in  camp  are  various,  the  facilities  ranging  from 
the  most  simple  and  crude  to  the  quite  elaborate.  Soup- 
carts,  baking-ovens,  and  so-called  fireless  cookers  may 
solve  some  of  the  problems;  but  the  knowledge,  in- 
dustry, and  management  of  the  company  commander, 
mess-sergeant,  and  cooks  must  be  relied  on  to  solve 
most  of  them.  They  must  utilize  to  the  utmost  the  ar- 
ticles of  the  ration,  and  such  other  good  food-supplies 
as  they  can  obtain,  and  the  equipment  furnished  for 
cooking  and  such  additions  to  it  as  they  have  or  can 
prepare ;  and  must  put  to  use  or  minimize  the  harm  of 
natural  factors,  such  as  wind,  rain,  snow,  or  poor  fuel. 
It  is  the  ability  to  do  this  last  that  enables  some  men 
who  are  not  very  good  cooks  in  garrison  to  excel  in  the 
field.  While  a  man  knowing  more  of  cookery  may  let  a 
meal  be  spoiled  or  uncooked  because  of  poor  fuel,  rain, 
and  adverse  winds,  another  man  may  have  an  excellent 
fire  and  a  well-cooked  meal  in  spite  of  all  three.  Camp 
craft  results  from  experience  and  ingenuity,  and  the 
one  should  be  furnished  by  manoeuvre-camps  and  prac- 
tice-marches, and  the  other  encouraged  by  observant 
company  commanders  when  it  manifests  itself.  The 
man  possessing  these  qualities  will  get  the  most  from 


88    THE  RECRUIT  AND  HIS  ENVIRONMENT 

his  utensils  and  his  fire,  whether  he  has  a  fully  equipped 
camp-stove,  a  spider  and  pots,  or  merely  a  trench  of 
his  own  digging. 

As  far  as  possible,  men  coming  in  from  a  march  or 
a  guard  should  be  supplied  with  hot  food  at  once,  and 
when  camp  is  changed  an  effort  should  be  made  to 
supply  a  hot  meal  as  soon  as  the  regular  meal-time 
comes.  This  means  the  use  of  kitchen  carts  or  fireless 
cookers,  or  the  early  establishment  of  the  kitchen  and 
the  use  of  food  that  can  be  quickly  cooked. 

As  in  garrison  so  in  camp,  cleanliness  of  cooks, 
kitchen,  and  food  are  secondary  only  to  the  actual  sup- 
ply of  food,  and  the  lack  of  it  will  do  more  harm  than 
partial  starvation.  Flies  have  greater  opportunities  to 
breed  in  camps  than  in  garrison,  dust  is  more  abun- 
dant and  blows  about  more  freely,  fecal  contamination 
of  hands,  shoes,  and  clothing  occurs  more  readily,  and 
the  facilities  for  storing  food  so  as  to  protect  it  from  all 
these  are  poorer.  Consequently,  the  amount  of  care  to 
be  exercised  is  greater,  and  the  necessity  for  minute  and 
thorough  cleanliness  more  urgent.  The  hands,  persons, 
and  clothing  of  the  cooks  and  assistants  should  receive 
the  greatest  care.  Tables,  benches,  blocks,  cooking 
utensils,  and  everything  about  the  kitchen  should  be 
cleaned  as  soon  as  used,  and  scalded,  if  it  be  possible, 
with  boiling  water.  Boxes  and  bags  containing  food 
should  be  frequently  inspected  inside  and  out,  and  their 
positions  shifted,  in  order  that  insects  may  not  gather 
in  or  about  them.  They  should  always  be  kept  clean. 
Kitchen  floors  and  surroundings  should  be  raked,  swept, 
or  scrubbed  after  each  meal,  so  that  all  particles  of  food 
and  everything  that  might  attract  flies  will  be  removed. 
Slop-buckets  and  garbage-cans  should  be  washed  after 


CAMPS  89 

each  emptying,  and  not  allowed  to  become  crusted  with 
a  greasy  coat  of  filth.  At  least  once  a  day  a  rigid  in- 
spection of  the  kitchen  should  be  made  and  all  points 
of  kitchen  police  investigated.  Reliable  men  should  be 
put  on  this  duty  and  rewarded  for  its  proper  perform- 
ance. Mosquito  netting  or  wire-gauze  covers  should 
be  provided  for  the  protection  of  food  while  it  is  await- 
ing preparation  or  serving.  Sheeting  or  boxes  should 
protect  it  from  dust. 

It  is  questionable  whether  screening  the  entire  kitchen 
is  always  advisable.  Cleanliness  is  necessary  in  keeping 
down  flies,  and  if  a  kitchen  is  screened  all  around  it  is 
darker  and  has  more  angles  and  comers  in  which  dirt 
and  scraps  may  collect  to  attract  them.  As  the  door  is 
of  necessity  frequently  opened,  they  enter  and  are  then 
kept  in  by  the  screening.  Screening  is  an  aid  in  pre- 
serving the  food  uncontaminated,  but  it  does  not  justify 
even  the  partial  neglect  of  the  more  important  matter 
of  scrupulous  cleanliness. 

The  kitchen  fire  should  constitute  a  small  crematory 
for  kitchen-waste,  and  the  cook  should  endeavor  to  be 
as  independent  as  he  can  of  civilian  scavengers  and 
fatigue  parties.  Nearly  all  scraps  and  solid  waste  that 
are  to  be  thrown  away  can  be  burned  by  him,  and  at 
times  he  can  take  care  of  most  or  all  of  his  dirty  water 
by  devices  to  be  described  later.  Every  tin  can  that  is 
emptied  should  be  thrown  into  the  fire  and  all  organic 
matter  in  or  on  it  destroyed.  Later  it  may  be  hauled 
away  or  buried. 

The  Arnold  pit  has  been  much  used  for  some  years 
and  has  often  given  great  satisfaction.  It  is  prepared 
as  follows :  A  pit  is  dug  about  60  inches  long,  30  inches 
wide,  48  inches  deep  at  one  end,  and  36  inches  deep  at 


90    THE  RECRUIT  AND  HIS  ENVIRONMENT 

the  other.  It  is  filled  loosely  with  stones  to  a  height  a 
few  inches  above  the  general  ground-level,  and  is  banked 
on  all  sides  to  protect  it  from  surface-water.  The  kitchen 
fire  is  built  on  these  stones,  and  is  inclosed  on  the  sides, 
but  the  ends  of  the  trough  thus  made  are  left  open.  All 
watery  material,  such  as  waste  coffee  and  dish-water,  is 
poured  on  the  stones  at  the  shallow  end  of  the  pit.  The 
heat  of  the  stones  evaporates  it.  All  solid  waste,  includ- 
ing tin  cans,  is  burned  in  the  fire.  The  ashes  and  debris 
are  removed  as  often  as  it  becomes  necessary.  This  ar- 
rangement is  improved  by  having  the  liquid  waste  first 
strained  by  passing  it  through  a  layer  of  straw  or  ex- 
celsior six  inches  deep,  which  would  catch  much  of  the 
fine  solids  and  grease  in  it.  The  straw  should  then  be 
burned  and  fresh  supplied  once  or  twice  daily.  It  might 
be  placed  in  the  bottom  of  a  large  tin  or  other  box,  or 
in  a  shallow  pit  that  drained  into  the  larger  one.  At 
other  times,  when  the  particular  conditions  would  war- 
rant it,  the  water  could  be  led  away  to  a  stream  by  such 
a  filled  trench  as  was  described  for  the  bath-water, 
provided  it  were  first  strained  through  straw.  Otherwise 
the  trench  would  soon  become  foul  with  a  deposit  of 
soap,  grease,  and  food-particles.  When  garbage  and 
waste  water  are  hauled  away  for  disposal  elsewhere,  the 
matter  of  emptying  them  from  cans  and  loading  them 
into  wagons  should  be  carefully  done  under  the  super- 
vision of  a  responsible  man,  with  a  view  to  the  preven- 
tion of  spilling  and  the  immediate  cleaning  up  of  any 
that  may  occur.  Receptacles  should  be  washed  inside 
and  out  immediately  after  emptying,  and  should  at  all 
other  times  be  kept  tightly  covered.  Lime-washing  the 
outsides  of  cans  and  the  stands  on  which  they  rest 
renders  the  detection  of  dirt  easier  and  is  recommended. 


CAMPS  91 

If  abundance  of  good  food  is  provided  in  the  messes, 
the  men  have  no  proper  excuse  for  indulging  in  im- 
proper food  obtained  from  peddlers,  and  such  persons 
should  be  excluded  from  the  camp  and  its  environs. 

Papers,  sweepings,  and  other  ordinary  camp  litter,  as 
well  as  horse-manure  and  stable-dirt,  should  be  burned, 
and  such  disposal  of  it  is  easy  and  conven- 
ient.  If  not  so  disposed  of,  it  is  apt  to  become  ^ 

scattered,  create  a  nuisance,  and,  particu- 
larly,  to  do  harm  as  affording  breeding- 
places  for  flies.  A  crematory  may  readily  be  impro- 
vised, and  if  a  good  draught  is  furnished,  it  may  be 
kept  burning  continually  with  waste  as  fuel.  Three 
forms  of  pit  or  crematory  are  as  follows,  and  any  one 
of  them  may  be  easily  and  quickly  constructed :  — 

1.  A  circular  pit  with  a  cone  of  stones,  around  which 
the  fire  is  built,  piled  up  in  the  middle. 

2.  A  horseshoe-shaped  mound  of  earth,  or  a  niche 
dug  in  a  bank,  or  a  trench  open  at  one  end. 

3.  A  cylindrical  crematory,  which  may  vary  in  size 
according  to  the  size  of  the  command  and  the  amount 
of  material  to  be  burned.  It  may  be  made  of  mud, 
stones,  brick,  corrugated  iron  roofing,  old  garbage  cans, 
or  whatever  is  available  and  suitable.  In  general,  its 
height  should  equal  or  exceed  its  diameter ;  it  should 
have  three  or  four  openings,  each  eight  to  twelve  inches 
square,  placed  at  equal  intervals  around  the  bottom  as 
air  inlets.  If  iron  bars  are  available  they  may  be  built 
into  the  cylinder  to  form  a  grate  above  the  level  of  the 
air  inlets.  In  rainy  seasons  a  roof  or  other  covering 
should  be  provided.  The  writer  has  seen  excellent 
results  from  all  the  following  types  of  cylindrical 
crematory :  — 


92    THE  RECRUIT  AND  HIS   ENVIRONMENT 

(a)  One  built  of  mud  plastered  thick  around  a  bar- 
rel. Inlets  are  provided  and  the  fire  lighted.  As  the 
barrel  burns  out  the  mud  bakes.  This  size  will  suffice 
for  a  company. 

(b)  One  made  from  three  widths  of  corrugated  iron 
roofing,  each  three  or  four  feet  long  and  each  having 
a  square  measuring  eight  or  ten  inches  cut  from  one 
corner  of  it.  The  three  pieces  are  hooked  together  with 
wire  in  such  a  manner  as  to  distribute  openings  left  by 
the  missing  squares  at  equal  intervals  around  the  bot- 
tom of  the  cylinder.  When  set  up  this  cylinder  should 
be  braced  and  steadied  by  piling  mud  or  sod  about  it. 
It  should  suffice  for  two  companies  and  has  the  ad- 
vantage of  being  transportable  in  very  small  space  if 
the  sheets  are  merely  unhooked  and  laid  flat  one  on 
another. 

(c)  Any  size  at  all  may  be  made  from  stone  or 
bricks  plastered  with  mud.  One  having  the  inside  di- 
ameter of  three  or  four  feet  at  the  top  and  a  height  of 
five  feet  or  more  should  dispose  of  all  the  refuse  of  a 
regiment.  One  such  in  a  camp  of  the  6th  California 
Infantry  in  1910  one  day  sei-ved  to  cremate  a  horse  and 
another  day  a  cow,  in  addition  to  the  regimental  refuse. 

Like  all  other  types  of  incinerator  this  requires  mod- 
erately intelligent  handling,  as  it  is  of  course  possible 
to  smother  almost  any  fire.  The  proper  method,  in  case 
there  is  no  grate  to  the  incinerator,  is  to  place  large 
stones  or,  preferably,  empty  cans  loosely  in  the  bottom, 
so  that  air  may  pass  among  them  freely.  On  these,  or 
on  the  grate,  place  a  little  wood  and  the  dryest  refuse 
and  light  it.  Then  place  some  wetter  refuse,  then  dry, 
and  so  on  until  the  mass  is  well  lighted.  Continue  to 
put  on  small  amounts  of  refuse  at  a  time,  not  filling  the 


CAMPS  93 

cylinder  but  placing  the  material  against  the  side  toward 
which  the  wind  is  blowing.  At  evening  the  incinerator 
may  be  filled  and  allowed  to  smoulder  all  night.  Next 
morning  it  should  be  started  again  with  wood. 

Other  forms  of  incinerator  may  be  improvised  to  suit 
conditions,  and  bits  of  stove-pipe  or  other  means  of  im- 
proving the  draft  or  protecting  the  fire  from  rain  can 
be  utilized.  These  pits  must  be  cleaned  as  necessary, 
and  the  ashes  and  unconsumed  matters,  such  as  tia 
cans,  placed  where  they  cannot  constitute  a  nuisance. 

The  proper  disposal  of  the  products  of  human  waste, 
feces  and  urine,  so  that  they  may  not  create  a  nuisance 
or  constitute  a  source  of  danger,  is  one  of    „ 

FCCGS 

the  most  important  problems  of  camp  sani-  _  ,_  . 

tation.  ihe  methods  available  are  incmer- 
ation,  water  carriage,  various  forms  of  carriage  on  land, 
and  disposal  in  the  soil.  Considering  these  in  turn  it 
may  be  said  of  incineration  that  it  possesses  the  advan- 
tage of  safe  and  sanitary  disposal  with  sterilization,  it 
does  not  attract  and  breed  flies  and  does  not  contami- 
nate the  soil  or  the  water  supply.  On  the  other  hand, 
the  first  cost  of  the  incinerator  is  large,  the  cost  of  up- 
keep and  fuel  excessive,  carelessness  in  handling  leads 
to  the  development  of  bad  odors,  and  the  equipment 
necessary  constitutes  such  a  mass  of  impedimenta  as  to 
make  its  removal  ordinarily  impracticable  when  the 
troops  are  moved.  The  method  may  therefore  be  con- 
sidered in  most  instances  an  unattainable  ideal. 

Water  cai'riage  is  in  some  exceptional  instances  an 
excellent  method  of  disposal.  The  conditions  under 
which  this  is  true,  however,  are  relatively  few.  It  may 
be  applicable  if  the  camp  is  known  to  be  permanent  or 
semipermanent  in  character  and  is  situated  on  or  close 


94    THE  RECRUIT  AND  HIS  ENVIRONMENT 

to  tidal  water  or  a  stream  not  used  for  drinking  pur- 
poses, that  will  remove  the  excreta  promptly  or  at  short 
intervals.  It  may  also  be  used  in  camps  of  very  tempo- 
rary character  if  they  are  so  situated  in  regard  to  tidal 
or  running  water  as  to  make  its  utilization  for  the  pur- 
pose both  simple  and  inexpensive,  for  instance,  the 
building  of  seats  out  over  the  water.  In  the  former  case 
the  installation  may  be  anything  from  a  complete  sew- 
erage and  water  closet  system  to  one  as  simple  as  in  the 
latter  case.  Of  intermediate  arrangements  a  good  one 
is  the  use  of  troughs  of  the  Reed  trough  type,  connected 
at  their  lower  ends  with  drains  of  glazed  tile  that  are 
laid  with  a  good  fall.  The  outlet  of  the  trough  may  be 
closed  by  a  hollow  cylinder  open  at  the  level  at  which 
it  is  desired  that  the  water  should  stand,  say  twelve 
inches  from  the  bottom.  Through  this  the  accumulating 
fluid  finds  exit,  and  once  a  day  or  oftener  the  whole 
trough  is  flushed  by  simple  removal  of  the  cylinder. 

Another  plan,  that  has  been  found  to  afford  a  certain 
amount  of  satisfaction  in  a  permanent  camp  emptying 
its  waste  into  a  small  stream,  includes  large  closed 
boxes  or  tanks  made  of  concrete,  though  wood  might 
be  used,  into  and  through  which  the  sewage  flows  and 
in  which  enough  sedimentation  and  disintegration  oc- 
cur to  make  the  outflow  a  pale,  opalescent  fluid  almost 
free  from  odor  and  easily  visible  particles.  It  is  not 
contended  or  thought  that  the  sewage  is  thus  purified, 
but  the  plan  has  two  distinct  advantages  in  that  it  al- 
most does  away  with  bad  odor,  and  it  offers  no  encour- 
agement for  the  breeding  of  flies.  Despite  its  advantages 
at  times,  water  carriage  of  excreta  is  rarely  applicable 
in  camps,  especially  in  campaign. 

Disposal  by  what  may  be  called  "  land  carriage  "  in- 


CAMPS  95 

eludes  those  methods  that  necessitate  carrying  or  haul- 
ing the  excreta  through  or  about  the  camp,  among 
them  the  pail  system,  the  dry  earth  closet,  carts,  and 
Reed  troughs.  They  all  have  the  common  fault  that, 
while  they  provide  for  the  reception  of  the  excreta  as 
passed  from  the  man,  the  matter  of  its  ultimate  dispo- 
sition remains  to  be  solved,  and  a  satisfactory  solution 
is  always  dijB&cult  and  at  times  impossible.  Among  the 
expedients  resorted  to  have  been  burial,  burning,  dump- 
ing at  a  distance  from  camp,  dumping  into  water,  and 
disposal  in  large  pits.  All  are  imperfect,  laborious,  ex- 
pensive, and  unsatisfactory,  they  are  apt  to  constitute 
nuisances,  to  attract  and  breed  flies,  to  pollute  water 
supplies,  and  in  many  instances  to  pollute  the  surface 
of  the  ground.  Within  the  writer's  experience  one  of 
the  most  satisfactory  of  these  methods  has  been  the  dis- 
position of  the  contents  of  Reed  troughs  into  large  pits 
where  the  surface  of  the  refuse  was  kept  covered  with 
a  layer  of  crude  petroleum.  This  resulted  in  absence 
of  odor  and  of  flies,  but  the  labor  involved  in  handling 
excreta  from  troughs  was  considerable,  that  in  digging 
pits  more,  and  accidents  occasionally  happened  which 
resulted  in  pollution  of  the  ground  in  camp.  Such  acci- 
dents are  liable  to  occur  with  any  system  that  requires 
the  handling  or  carrying  of  dejecta  through  camp.  In 
addition  each  method  has  inherent  objectionable  fea- 
tures. Pails  and  boxes  require  much  labor  to  clean  them 
and  much  supervision  is  necessary  to  see  that  the  clean- 
ing is  thorough  and  that  covers  are  kept  on  in  intervals 
of  use,  otherwise  bad  odors  and  flies  abound.  Dry  earth 
closets  are  often  not  to  be  used  properly  because  of  lack 
of  dry  earth,  the  impracticability  of  separating  feces 
and  urine,  the  consequent  mass  of  feces  and  mud  to  be 


96    THE   RECRUIT  AND  HIS  ENVIRONMENT 

handled,  and  the  impossibility  of  keeping  flies  away 
from  such  a  mixture.  Like  pails  and  boxes,  earth  closets 
are  not  easily  moved  with  the  troops.  Latrine  carts  are 
highly  expensive  because  of  the  transportation  and 
labor  they  monopolize.  Reed  troughs  also  demand  large 
expenditure  in  money,  labor,  and  transportation,  and  in 
addition,  if  used  with  lime  in  accordance  with  the  War 
Department  order  prescribing  their  use,  they  neither 
sufficiently  repel  flies  nor  do  away  with  bad  odor.  It 
may  be  said  though,  that  both  of  these  objections  may 
be  met  by  the  use  of  crude  petroleum  instead  of  lime. 
The  objections  set  forth  above  will  in  most  camps,  es- 
pecially of  mobile  troops,  be  sufficient  to  prevent  the 
use  of  any  method  of  disposal  calling  for  transportation 
of  excreta  by  land,  and  it  therefore  happens  that  we 
still  resort  to  those  ancient  methods  that  have  at  other 
times  been  so  faulty  that  all  of  these  we  have  been  con- 
sidering were  evolved  as  substitutes  for  or  improve- 
ments upon  them,  namely,  disposal  on  or  in  the  soil. 

Of  these  methods  there  are  three  principal  ones :  — 

Disposal  on  the  surface  of  the  ground  with  little  or 
no  covering. 

Shallow  burial. 

Deep  burial. 

The  first  named  method  usually  merits  only  condem- 
nation, as  leading  to  contamination  of  soil,  persons, 
water  and  flies,  though  it  occasionally  happens  that 
circumstances  will  justify  it.  In  a  certain  camp  near 
San  Diego,  for  instance,  "hardpan"  as  hard  as  most 
sandstones  was  found  at  or  within  a  foot  or  two  of  the 
surface.  The  digging  of  deep  trenches  was  impossible, 
as  picks  and  crows  were  soon  blunted  and  rendered 
useless,  and  when  a  trench  was  cu^  out  to  a  depth  of 


CAMPS  9T 

two  and  a  half  feet  the  soil  was  so  non-absorbent  that 
urine  quickly  filled  it.  In  the  neighborhood  were  some 
small  areas  where  the  overlying  soil  was  deep  enough 
to  permit  of  plowing,  and  this  had  been  done.  A  con- 
stant wind  was  blowing,  and  it  was  found  that  urine 
and  strained  kitchen  water  when  thrown  on  this  plowed 
ground  to  the  leeward  of  camp  was  absorbed  by  the 
loose  soil  and  held  until  wind  and  sun  completed  its 
speedy  evaporation.  Such  a  method  of  urine  disposal  is 
certainly  not  ordinarily  desirable,  but  in  the  case  in 
question  it  was  the  best  and  safest  available  method, 
and  military  hygiene  must  in  practice  consist  largely  of 
doing  the  best  thing  possible  at  the  time  and  place. 

The  second  method  of  soil  disposal,  burial  in  shallow 
trenches,  seems  to  have  had  considerable  use  in  the 
British  and  Indian  services,  but  it  should  not  be  used 
in  camps  of  more  than  a  few  (lays'  duration,  unless 
special  circumstances  make  it  appear  the  safest  or  only 
available  plan.  Its  most  obvious  faults  are  that  flies 
can  breed  in  feces  exposed  to  them  and  then  buried  to 
a  depth  of  only  six  to  ten  inches,  that  a  relatively  large 
amount  of  ground  is  necessary,  that  soiling  of  the  feet 
with  fecal  matter  is  rendered  more  probable,  that  soiled 
paper  is  apt  to  be  blown  about  camp,  that  a  relatively 
light  rain,  especially  in  the  tropics,  will  flood  such  shal- 
low pits  and  diffuse  their  contents.  When  used  the 
system  calls  for  the  constant  presence  of  a  sufficient 
guard  to  see  that  each  man  covers  his  own  dejecta,  that 
toilet  paper  is  properly  enclosed,  weighted,  or  (after 
use)  covered,  and  to  attend  to  the  final  filling,  packing, 
and  turfing  of  each  trench  at  the  proper  time.  The  use 
of  crude  petroleum  in  the  trench  and  as  a  partial  cov- 
ering for  the  fecal  matter  wqu14  lessen  odor  and  flies. 


98    THE  RECRUIT  AND  HIS  ENVIRONMENT 

The  de&p  trench  latrine  is  the  form  used  in  our  camps 
of  concentration  in  1898,  and  it  was  condemned  then 
and  many  times  since  as  a  contaminator  of  persons, 
soil,  and  water,  a  breeder  of  flies  and  of  smells,  and  a 
constant  source  of  supply  where  flies  might  and  did 
load  up  with  typhoid  bacilli  before  visiting  the  kitchen 
and  mess  tents.  All  of  this  was  true,  but  more  recently, 
since  the  importance  of  preventing  pollution  of  the  sur- 
face of  the  ground  and  of  preventing  access  of  flies  has 
been  appreciated,  and  since  actual  and  extensive  prac- 
tice has  demonstrated  the  feasibility  and  value  of  such 
precautions,  it  need  be  true  no  more.  The  danger  to 
be  feared  from  a  proper  use  of  deep  trench  latrines  is 
pollution  of  the  ground  water,  but  as  the  introduction 
of  a  good  supply  of  drinking  water  from  outside  the 
camp  is  nearly  always  resorted  to  anyhow,  that  is  not 
a  vital  objection,  and  ease  of  construction  and  sim- 
plicity make  it  certain  that  this  form  of  disposal  will 
long  be  used.  When  used  though,  the  trench  should  be 
properly  constructed  and  cared  for  if  the  evils  above 
enumerated  are  to  be  avoided.  First  of  all  it  should  be 
dug  to  a  suitable  depth,  usually  six  feet  or  more,  and 
protected  from  rain,  washings,  and  caving.  Then  it 
should  be  covered  with  a  box  seat  with  hole  covers  that 
close  automatically,  and  all  cracks  and  crevices  closed 
in  such  a  manner  that  the  pit  is  made  quite  dark  and 
fly  proof.  Separate  urinals  of  tin  or  tarred  paper  fun- 
nels opening  into  the  pit  by  small  angular  tunnels 
should  be  placed  at  each  end.  They  may  be  made  im- 
passable to  flies  by  stuffing  them  lightly,  toward  the 
bottom,  with  grass  or  straw,  although  painting  them 
inside  each  day  with  crude  petroleum  suffices  for  this 
and  keeps  down  odor. 


CAMPS  99 

Various  improvisations  of  pit  covers  can  be  made 
that  will  require  relatively  little  lumber,  if  tarred  pa- 
per, burlap,  or  cheap  muslin  be  substituted  for  it  on 
the  sides  and  ends  of  the  box  and  for  seat  covers.  By 
keeping  in  mind  the  requirements  of  making  the  pit 
dark  and  fly  proof  the  resourceful  officer  can  nearly 
always  devise  a  satisfactory  cover. 

As  to  the  subsequent  care  of  the  pits,  it  is  thought 
that  crude  petroleum  has  advantages  that  put  it  in  a 
class  by  itself  as  a  pit  dressing.  It  keeps  down  bad 
odors  to  a  remarkable  degree,  is  repellent  to  flies,  does 
away  with  the  use  of  earth  or  lime  in  pits,  and  indefi- 
nitely prolongs  their  usefulness  in  absorbent  soils  ;  it  is 
easily  handled  and  transported,  and  is  of  great  value 
for  many  other  sanitary  purposes  about  camp.  It  should 
be  used  to  paint  the  insides  of  urinal  funnels  and  to 
sprinkle  over  the  surface  of  the  pit  contents  each  day. 

Crude  petroleum  appears  to  owe  its  value  as  a  pre- 
ventive of  fly  breeding  mainly  to  the  fact  that  it  is 
repellent  to  adult  flies.  If  maggots  once  hatch  in  a 
petroleum-treated  pit  they  are  apt  to  develop  about  as 
usual,  despite  the  daily  sprinkling  with  oil.  Neverthe- 
less, the  treatment  is  still  worth  while,  as,  if  continued 
regularly,  it  keeps  egg-laying  adult  flies  away  and  limits 
the  output  of  the  pit  to  the  one  crop  of  flies.  Without 
the  treatment  numerous  crops  would  appear. 

Other  methods  of  caring  for  pits  are  also  in  use  but 
are  not  so  satisfactory.  Earth  and  lime  are  sometimes 
used  to  cover  each  day's  dejecta.  They  do  not  keep 
down  odors  or  prevent  fly  breeding  as  well  as  the  oil 
does,  and  they  rapidly  fill  the  pit  and  lessen  its  period 
of  usefulness  and  necessitate  extra  labor  to  dig  others. 
The  burning  out  of  pits  has  also  been  much  used  and 


100    THE  RECRUIT  AND  HIS   ENVIRONMENT 

has  usually  given  satisfaction.  The  results  are  about 
the  same  as  from  the  above  described  use  of  oil,  and 
when  that  is  the  case  it  seems  a  waste  of  labor  to  over- 
turn each  pit  cover  and  replace  it  each  day,  not  to  men- 
tion the  waste  of  fuel  and  the  sometimes  disagreeable 
features  attending  the  burning. 

The  Jepson  latrine  and  kitchen  pits  were  among  the 
earlier  successful  types  of  dark  and  fly  proof  pits,  and 
excellent  results  have  been  reported  from  their  use  in 
proper  soils.  They  differ  from  other  pits  in  that  they 
are  dug  with  a  post  hole  auger  and  are  small  in  diam- 
eter, but  deep.  They  are  to  be  covered  in  and  made 
fly  proof. 

Urinals  should  always  be  provided  in  camp,  so  that 
the  men  will  neither  need  to  urinate  promiscuously 
through  the  camp  nor  to  wet  and  soil  the  latrine  seats. 
The  day  urinal  may  be  a  trough  or  a  funnel  of  wood, 
tin  plate,  or  tarred  paper,  that  conducts  the  urine  to  a 
dark  and  preferably  fly  proof  soakage  pit.  The  funnel 
or  trough  should  be  painted  with  crude  oil  each  day,  if 
possible,  and  great  care  should  be  taken  to  insure  a8 
far  as  possible  that  the  men  do  not  urinate  on  the 
ground  near  the  urinal  and  so  make  a  muddy  and  foul 
place.  In  case  oil  is  not  available  for  troughs  and  fun- 
nels, fairly  satisfactory  urinals  may  be  made  by  dig- 
ging pits  and  filling  them  with  stones,  or  they  may  be 
filled  with  sawdust,  or  barrels  or  boxes  with  both  ends 
knocked  out  may  be  half  buried  and  similarly  filled. 
Pine  needles  and  sawdust  are  reputed  to  be  especially 
valuable  for  filling  because  they  minimize  or  prevent 
the  odor  of  decomposed  urine. 

Night  urinals  consist  of  large  cans  or  half  barrels, 
to  be  placed  in  the  company  streets  at  night,  and  to  be 


CAMPS  101 

carried  away  and  emptied  and  washed  in  the  morning. 
If  one  emptying  does  not  suffice  to  prevent  overflow  or 
spilling,  they  should  be  emptied  also  at  ten  o'clock  at 
night.  They  should  be  marked  at  night  with  lanterns, 
so  that  they  may  be  located  easily.  During  the  day, 
when  not  in  use,  they  should  be  kept  clean  and  dry  and 
exposed  to  the  sun. 

The  general  interest  of  officers  in  the  prevention  of 
disease  and  their  knowledge  of  the  subject  has  increased 
so  much  in  recent  years  that  they  usually  show  them- 
selves efficient  in  maintaining  good  conditions.  Never- 
theless, they  as  well  as  the  medical  officer  would  be 
greatly  helped  if  each  company  had  an  enlisted  man 
whose  duty  it  was  to  study  and  look  after  sanitary  con- 
ditions. Army  experience  had  convinced  the  writer  of 
this,  and  his  experience  on  the  Canal  Zone,  where  non- 
medical men  who  were  formerly  carpenters,  railroad 
men,  engineers,  foremen,  soldiers,  and  so  forth,  have 
been  trained  by  working  experience  to  become  sanitary 
inspectors  and  have  rendered  service  of  the  highest 
value,  has  strengthened  the  conviction.  Such  a  trained 
man  in  each  company  would  be  of  the  greatest  value 
to  the  organization  and  to  the  surgeon.  Having  ac- 
quired his  training  and  demonstrated  his  value  he 
should  have  non-commissioned  rank  and  pay. 

Camp  sanitary  work  may  at  times  need  to  extend 
beyond  the  camp  and  may  include  the  improvement  or 
protection  of  a  water  supply,  the  search  for  and  elim- 
ination of  mosquito  breeding  in  large  areas,  the  drain- 
ing of  swamps,  petrolizing  of  pools,  grading  and  ditch- 
ing of  ground,  the  clearing  of  brush,  and  the  regulation 
or  control  of  traffic  in  food  stuffs.  Under  certain  condi- 
tions it  may  include  a  quarantine  system,  a  war  on  rats. 


102    THE  RECRUIT  AND  HIS  ENVIRONMENT 

a  house-to-house  inspection  of  civilians,  the  control  of 
epidemics,  or  the  sanitation  of  entire  towns  or  districts. 
In  all  of  these  cases  trained  men  are  of  especial  value 
to  the  sanitary  officials  as  well  as  to  the  company, 
though  their  value  to  the  latter  is  constant. 


CHAPTER  VI 

THE  HYGIENE  OF  MOVING  TROOPS 

The  march,  the  battlefield,  changes  by  ship  and  rail, 
all  present  their  special  problems  of  sanitation,  neglect 
of  which  may  result  in  disaster  to  the  careless  command 
or  to  its  friends  and  allies.  Many  men  and  some  offi- 
cers are  apt  to  ignore  the  latter  phase  of  the  question 
and  to  think  that  when  they  have  avoided  harm  to 
themselves  and  their  companies  they  have  performed 
their  full  duty  in  sanitary  matters.  Nowhere  is  a  man 
his  brother's  keeper  to  a  greater  degree  than  in  an 
army,  and  it  is  hoped  that  the  fact  may  become  more 
fully  appreciated. 

Article  V  of  the  Field  Service  Regulations  deals  well 
with  the  subject  of  marches ;  but  the  rules  there  given 
should  be  applied  with  discretion.  It  must  ^, 
be  remembered  that  the  various  possible 
states  of  weather,  roads,  and  personnel  may  result  in 
an  almost  infinite  variety  of  circumstances,  all  of 
which  could  not  possibly  be  considered  in  any  set  of 
printed  rules.  Much  must  depend  on  the  judgment 
of  the  commanding  officer,  in  sanitary  as  in  tactical 
matters,  and  his  knowledge  or  lack  of  knowledge  of 
sanitation  may  determine  the  success  or  failure  of  a 
movement.  If  good  judgment  is  used  in  adapting  the 
regulations  to  the  circumstances,  the  rules  laid  down 
therein  will  constitute  a  reliable  general  guide.  The 
length  and  speed  of  the  march,  for  instance,  must  be 
materially  influenced  by  climate,  weather,  roads,  water, 


104    THE  RECRUIT  AND  HIS  ENVIRONMENT 

transportation,  weight  carried,  amount  and  character 
of  sickness  in  the  command,  the  rations,  character 
and  state  of  the  clothing,  the  spirits  of  the  command, 
the  objective,  temperance  in  the  use  of  intoxicants,  and 
other  factors. 

The  length  and  frequency  of  rests  must  be  influenced 
by  much  the  same  factors,  and  the  commander  who 
sets  a  pace  and  determines  the  frequency  and  duration 
of  rests  without  regard  to  these  influences  is  not  doing 
justice  to  his  men.  The  time  of  day  during  which  the 
march  is  to  be  made  will  also  influence  the  length, 
speed,  and  rests,  and  the  choice  of  it  must  in  turn  be 
influenced  by  diverse  considerations.  Thus  the  temper- 
ature may  make  daytime  marching  very  trying,  yet 
the  state  of  the  roads,  the  possibility  of  malarial  or 
other  infections,  the  presence  of  sick,  and  other  consid- 
erations, may  make  it  appear  the  lesser  of  evils.  It  is 
always  well,  therefoi'e,  to  consider  these  various  influ- 
ences and  to  bear  in  mind  that  the  command  brought 
into  camp  in  good  spirits  and  good  condition  after 
what  may  be  a  relatively  short  march,  is  in  better  con- 
dition for  large  accomplishments  on  the  morrow,  than 
another  command  that  has  marched  five  miles  farther, 
but  has  reached  camp  with  the  men  footsore,  weary, 
discouraged,  and  with  their  vital  resistance  so  lowered 
as  to  be  ready  to  yield  to  the  inroads  of  any  chance 
infection.  The  influence  of  climate  and  weather  is  so 
quickly  manifested  on  the  men,  and  in  such  obvious 
and  well-known  ways,  as  not  to  need  much  discussion, 
and  a  moderate  amount  of  common  sense  and  consider- 
ation for  his  men  should  cause  an  officer  to  make  allow- 
ances for  them.  Heat,  wind,  snow,  rain,  fog,  slush, 
glare,   mugginess,  all  tire,   discourage,   and   tend   to 


THE  HYGIENE  OF  MOVING  TROOPS     105 

sicken  the  men,  shorten  the  march,  and  increase  the 
rests. 

Closely  related  to  these  is  the  state  of  the  roads. 
Mud,  excessive  dust,  loose  sand  or  gravel,  very  rough 
and  uneven  roads,  all  increase  delay,  vexation,  and 
fatigue,  and,  even  when  weather  conditions  are  good, 
may  cut  the  march  to  a  fraction  of  what  is  desired. 
Not  to  be  separated  from  the  question  of  roads  is  that 
of  transportation.  If  the  former  are  good,  abundant 
wagon  transportation  may  be  used,  if  available,  lessen- 
ing the  loads  of  the  men,  supplying  them  with  abundant 
food,  tentage,  and  other  necessities  and  comforts.  If 
they  are  bad,  transportation  facilities  may  be  much 
limited  in  consequence,  or,  if  furnished,  may  prove  a 
source  of  vexation  and  weariness,  the  men  having  to 
spend  hours  of  toil  extricating  mired  animals  or  wag- 
ons, in  unloading,  loading,  and  carrying  freight.  Such 
trials  of  body  and  spirit  react  on  the  health,  and  when, 
in  addition,  because  of  failure  of  the  transport  wagons, 
men  have  to  lie  down  supperless  and  without  proper 
shelter,  the  question  of  transportation  has  assumed  a 
sanitary  importance  of  magnitude. 

Intimately  related  to  the  question  of  transportation 
is  that  of  the  weight  carried  by  the  men,  and  the  at- 
tempt is  wisely  made  to  reduce  this  to  a  minimum ; 
yet  under  some  conditions,  and  generally  they  are  those 
in  which  men  should  have  to  carry  the  least,  as  in  bad 
weather,  over  bad  roads,  on  forced  marches,  after  very 
trying  campaigns  that  sicken  man  and  beast,  trans- 
portation may  fail  and  the  men  have  to  carry  extra 
ammunition,  food,  and  clothing.  If  this  is  a  necessity 
the  best  should  be  made  of  it  and  the  load  carried, 
but  the  march  should,  as  far  as  possible,  be  regulated 


106    THE  RECRUIT  AND    HIS  ENVIRONMENT 

to  suit  the  altered  conditions.  We  are  not  able  to  breed 
or  buy  men  as  we  do  horses,  with  a  view  to  their 
strength,  speed,  endurance,  or  spirit,  though  we  do 
attempt  to  select  them  with  a  view  to  these  qualities. 
Nevertheless,  each  organization  will  have  its  strong  and 
its  weak  men,  its  fast  and  its  slow,  its  cheerful  and 
its  despondent,  and  it  is  the  less  desirable  of  these  that 
must  be  most  considered  under  trying  conditions.  The 
weak  man  must  not  be  overloaded,  the  lame  man  over- 
marched,  because  the  more  able  men  can  march  far- 
ther or  carry  more.  Otherwise  they  will  become  sick, 
and  the  problem  is  worse  complicated  than  before. 
Disregard  of  this  simple  fact  has  been  known  to  re- 
sult in  most  serious  consequences.  Whatever  the 
weight  carried,  it  should  be  so  disposed  on  the  person 
as  to  carry  as  comfortably  as  possible,  and  not  constrict 
or  compress  the  chest.  As  stated  before,  it  is  on  the 
free  play  and  efficient  working  of  the  heart  and  lungs 
that  strength  and  endurance  depend.  If  the  chest  is 
compressed  and  its  mobility  lessened  by  tight  clothing, 
crossed  straps,  or  other  cause,  that  free  and  efficient 
working  are  impossible,  and  the  man  becomes  exhausted 
under  a  load  that  might  not  greatly  inconvenience  him 
if  it  were  more  wisely  disposed.  Experiments  have  de- 
monstrated that  inhalations  of  oxygen  enable  athletes 
to  run  farther  and  faster,  and  with  less  inconvenience, 
than  is  the  case  without  such  inhalations.  When  the 
action  of  either  the  lungs  or  heart  is  interfered  with, 
the  oxygenation  of  the  blood  is  hindered  and  early 
tiring,  weakness,  and  exhaustion  follow.  These  con- 
ditions constitute  not  only  disturbing  and  delaying 
factors  of  a  temporary  nature,  but  also  weaken  the  re- 
sistance to  disease  and  prepare  the  way  for  infections. 


THE  HYGIENE  OF  MOVING  TROOPS     107 

Sickness  in  the  command  that  is  moving  always 
occasions  delay,  often  very  much  extra  work,  and,  quite 
as  often,  danger  of  epidemics.  All  sick  should  there- 
fore be  left  behind,  if  possible,  when  the  march  begins; 
all  hygienic  measures  should  be  employed  to  prevent 
other  men  becoming  sick;  all  who  do  become  so  should 
report  to  the  medical  officer  as  soon  as  practicable  so 
as  to  get  the  benefit  of  early  observation,  treatment, 
and  care,  and  all  who  do  not  favorably  and  quickly  re- 
spond to  such  early  care  should,  if  possible,  be  provided 
for  on  the  way,  in  houses,  camps,  or  hospitals,  or  sent 
back,  and  not  allowed  to  hamper  and  constitute  a  dan- 
ger to  the  entire  command.  The  Field  Service  Regu- 
lations prescribe  that  the  sick  shall  be  eliminated  before 
the  start  is  made,  but  in  practice  certain  classes  of 
sick  are  not  always  eliminated  and  later  give  much 
trouble.  Among  these  are  venereal  cases.  Many  such  do 
not  appear  on  sick  report  unless  frequent  inspections  are 
made  and  they  are  ordered  to  report.  These  men,  though 
doing  full  garrison  duty  and  feeling  well,  are  likely  to 
develop  buboes  on  the  march  and  be  unfitted  for  either 
walking  or  horseback  riding. 

Men  recently  discharged  from  treatment  in  hospital 
for  malaria,  dysentery,  and  other  debilitating  diseases 
are  apt  to  become  exhausted  or  to  have  recurrences  of 
their  sickness  when  subjected  to  hard  marches. 

Weak  hearts  and  weak  feet  are  liable  to  break  down 
under  similar  conditions,  and  men  known  to  suffer  from 
either  should  be  excluded.  Not  only  should  sick  men 
be  excluded  from  the  march,  but  well  men  should  be 
taught  and,  if  necessary,  compelled,  to  conduct  them- 
selves in  such  a  way  as  to  maintain  their  efficiency  and 
strength.   Alcoholism,  particularly,  should  be  discour- 


108    THE  RECRUIT  AND  HIS  ENVIRONMENT 

aged,  and  all  straggling  to  get  alcohol  and  all  drinking 
in  ranks  should  be  punished ;  for  not  only  does  the  in- 
dulgence lead  to  inefficiency  from  drunkenness,  but  it 
predisposes  to  exhaustion,  infections,  injuries,  to  heat- 
stroke in  hot  weather  and  freezing  in  cold.  While  only 
harmful  and  not  to  be  encouraged  in  camp,  drinking, 
if  not  carried  to  excess  and  not  prolonged  into  the 
hours  belonging  to  sleep,  is  then  less  directly  harmful 
than  on  the  march. 

Cheerfulness  and  bright  hopes  are  powerful  stimu- 
lants to  accomplishment,  and  it  should  be  the  aim  of 
the  company  commander  to  keep  his  men  in  such  a 
state  of  mind.  Difficulties  may  often  be  laughed  away, 
while  if  given  too  much  thought  or  gloomily  dwelt  upon 
they  readily  become  insurmountable.  One  of  the  great 
items  in  Napoleon's  success  was  his  faculty  of  having 
his  men  accomplish  the  impossible. 

Hardships  may  be  magnified  in  retrospect;  on  the 
march  they  should  be  minimized  and  belittled,  if  un- 
avoidable. 

Another  occasional  cause  of  exhaustion  is  said  to  be 
the  reckless  and  excessive  indulgence  in  water.  The 
.^,  Field  Service  Regulations  state  that  under 

"ordinary  conditions  a  canteen  of  water 
should  last  a  man  a  day."  Ordinary  conditions  in  the 
field  are,  however,  hard  to  define,  and  the  amount  of 
water  needed  under  varying  conditions  and  by  differ- 
ent men  varies  greatly.  There  is  no  doubt  that  many 
men  do  use  water  injudiciously,  and  that,  by  training 
or  habit,  they  may  teach  themselves  such  moderation 
and  restraint  as  to  be  enabled  to  make  the  contents  of 
one  canteen  last  them  through  any  ordinary  day's 
march.   As  the  canteen  holds  two  and  one-half  pints 


THE  HYGIENE  OF  MOVING  TROOPS     109 

and  the  march  rarely  covers  more  than  eight  or  ten 
hours,  it  may  be  seen  that  this  should  not  involve  any 
hardship  for  a  well  and  fit  man.  It  is,  however,  a  well- 
recognized  fact  that  men  who  begin  a  march  with  the 
consumption  of  large  amounts  of  water,  and  who  early 
exhaust  their  canteens,  are  very  apt  to  become  ex- 
hausted or  to  fall  out  before  the  march  is  completed. 
The  consumption  of  the  water  is  not  always  the  sole 
cause  of  such  exhaustion,  but  both  may  be  the  effect  of 
a  common  cause,  such  as  sickness,  diarrhoea,  alcoholic 
indulgence,  excessive  smoking,  or  injudicious  eating  the 
night  before.  By  the  avoidance  of  such  indiscretions  the 
moderate  use  of  water  is  made  easy ;  but  if  a  man  has 
spent  a  part  of  the  night  in  alcoholic  indulgence,  smok- 
ing, and  eating  cheese  and  salt  herring,  his  system  is  so 
loaded  with  poisonous  waste-products  that  he  needs  a 
large  amount  of  water  to  dilute  and  remove  them,  and 
depriving  him  of  it  will  not  improve  his  condition  in 
any  way.  Aside  from  such  indiscretions,  more  water  is 
required  by  men  whose  food  is  very  salty  or  very  dry ; 
by  those  marching  in  a  hot  sun  or  losing  much  water  in 
the  form  of  perspiration,  or  those  marching  in  dust,  as 
at  the  rear  of  a  column.  Thus  we  see  that  while  "ex- 
cessive "  use  of  water  is  harmful,  its  liberal  use  is  not. 
On  the  other  hand,  insufficiency  of  water  is  harmful, 
even  when  not  causing  suffering  through  thirst,  in  hot 
weather  as  predisposing  to  sunstroke,  and  as  causing 
such  concentration  of  the  urine  as  to  cause  very  severe 
bladder  irritation,  with  burning  and  pain  that  occasion 
great  suffering  and  alarm.  It  is  nevertheless  highly 
desirable  that  men  should  so  conduct  and  so  train 
themselves  that  they  can  be  able  to  get  through  the 
marching  hours  without  using  more  than  one  canteen- 


110    THE   RECRUIT  AND  HIS   ENVIRONMENT 

fill  of  water;  and  if  for  any  reason  they  cannot  do  so, 
it  is  usually  better  that  they  should  go  thirsty  than  that 
they  should  drink  water  from  unknown  sources  or  of 
doubtful  character,  as  a  few  hours  of  discomfort  from 
thirst,  or  an  attack  of  pain  in  the  bladder,  are  to  be 
preferred  to  an  attack  of  typhoid,  cholera,  dysentery,  or 
parasitic  infestation.  Sunstroke,  however,  may  be  as 
fatal  as  any  of  these,  and  if  symptoms  of  it  appear, 
water  must  be  used,  under  the  direction  of  the  surgeon, 
if  one  be  present. 

The  water  problem  should  be  handled  as  follows :  — 
Before  the  march  is  begun,  an  abundant  quantity  of 
good  water,  boiled,  filtered,  or  purified  chemically,  if 
necessary,  should  be  supplied.  If  the  water  is  boiled, 
that  should  have  been  done  the  night  before,  in  order 
to  have  it  cool  in  the  morning.  If  other  vessels  are  not 
available,  it  may  be  put  in  the  canteens  the  night  before 
and  allowed  to  cool  in  them.  Each  man  should  drink 
what  he  wants  before  starting,  using  his  cup  for  the 
purpose,  and  have  his  canteen  filled  from  the  good 
supply.  Except  rarely,  he  cannot  know  that  the  water 
he  sees  later  in  the  day  will  be  suitable  for  drinking, 
and  he  should  therefore  drink  then  only  from  his  can- 
teen, and,  in  order  that  it  may  suffice,  exercise  great 
care  and  moderation  in  the  use  of  that  supply.  As  soon 
as  camp  is  reached  in  the  evening,  the  preparation  of 
a  fresh  supply  should  be  begun,  and,  if  boiling  is  the 
form  of  purification  used,  the  first  drink  furnished  may 
be  tea  or  coffee.  Reckless  or  careless  indulgence  in 
water  from  supplies  of  unknown  character  may  have 
the  most  disastrous  results. 

Field  Service  Regulations  say  that  "  sources  of  water 
supply  are  examined  by  experts  and  marked  good  or 


THE  HYGIENE  OF  MOVING  TROOPS     111 

had.''^  It  is  a  difficult  matter  and  a  time-consuming  proc- 
ess for  an  expert  to  determine  whether  or  not  a  water 
supply  is  good  or  bad,  and  on  the  march  a  medical 
officer  can  only  base  his  opinion  on  the  source  and  sur- 
roundings of  the  supply  as  he  can  see  them  or  learn  of 
them  from  others.  The  appearance,  odor,  taste,  and  such 
other  tests  as  he  is  able  to  apply  under  the  circumstances 
can  in  no  wise  assure  him  that  the  water  is  fit  to  drink. 
It  is  therefore  usually  desirable  that  all  water  from 
sources  not  well  known  to  be  good  should  be  purified 
by  heat  or  otherwise  before  use  for  drinking. 

Smoking  is  apt  to  increase  thirst  and  should  there- 
fore be  discouraged  on  the  march,  particularly  if  the 
water  supply  be  small  in  amount  or  of  poor  character. 
The  use  of  chewing  gum  tends  to  lessen  the  urgency 
of  the  desire  for  smoking  and  also  to  lessen  thirst,  and 
may  be  regarded  as  helpful  for  those  reasons.  It  is 
sometimes  urged  that  cold  weak  tea  or  coffee  be  carried 
in  the  canteen  and  drunk  on  the  march,  in  order  to  as- 
sure the  use  of  boiled  water.  Aside  from  the  possibility 
of  their  being  diluted  with  unboiled  water,  and  of  tea 
being  made  with  cold  and  unboiled  water,  these  drinks 
are  not  so  refreshing  and  thirst-satisfying  between  meals, 
to  most  Americans,  as  plain  water,  and  it  is  not  thought 
that  they  are  as  good  for  use  on  the  march  as  the  latter, 
provided  that  it  is  properly  purified  or  sterilized. 

The  food-supply  on  the  march,  as  elsewhere,  is  very 
important.  Because  of  the  greater  amount  of  work  per- 
formed, and  the  increased  tissue-changes 
due  to  the  outdoor  life,  the  amount  of  food 
required  on  the  march  exceeds  that  required  in  garrison ; 
while  because  of  the  few  and  imperfect  kitchen  facilities, 
the  new  and  strange  environment,  the  absence  of  water- 


112    THE  RECRUIT   AND  HIS  ENVIRONMENT 

closets,  and  for  other  reasons,  food  infection  is  more 
apt  to  occur,  and  every  effort  should  be  made  to  obtain 
cleanliness  and  to  serve  all  food  sterile,  rendered  so 
by  heat.  Because  of  the  exposure  to  which  the  men 
are  subjected,  diarrhoeal  troubles  are  readily  induced, 
and  instating  foods  should  be  avoided.  Except  in  rare 
instances  it  should  be  possible  to  furnish  two  hot  and 
substantial  meals  a  day  to  the  marching  column,  and 
that  should  be  done.  A  hot  breakfast  should  be  served 
before  the  march  is  begun,  and  it  should  be  a  substan- 
tial meal,  such  as  one  of  meat,  potatoes,  bread,  and  coffee. 
Eggs  and  similar  articles,  if  obtainable,  may  be  used. 
The  noon  meal,  also,  should  be  prepared  and  issued  to 
the  men  before  starting,  and  should  embrace  much 
nutriment  in  relatively  small  bulk.  Fried  bacon,  cheese, 
sliced  meat,  and  bread  meet  the  requirements  well,  while 
a  pickle,  a  bit  of  fruit,  or  jam  adds  to  the  enjoyment 
of  it.  In  the  evening,  after  the  hard  work  of  the  march 
is  ended,  the  men  should  have  another  hot  meal,  and  as 
they  will  have  leisure  to  digest  it,  it  should  be  more 
bulky  than  the  other  meals.  Stews,  if  well  made,  answer 
admirably,  and  may  be  supplemented  with  such  addi- 
tions as  are  obtainable.  Because  of  lack  of  fuel,  delay 
in  the  arrival  of  company  wagons,  the  necessity  of  start- 
ing fires  and  doing  the  cooking  after  the  halt  is  made, 
the  evening  meal  is  often  late  ;  and  if  they  can  obtain 
other  food  many  men  eat  it,  often  with  little  regard  to 
its  suitability.  It  is  hoped  that  soup-carts,  ambulance 
kitchens,  and  fireless  cookers  will  correct  this  by  having 
a  ready  cooked  and  hot  meal  prepared  when  the  halt  is 
made.  Because  of  their  portability,  canned  and  pre- 
served foods  are  much  used  on  marches,  and  the  usual 
precautions  are  necessary  to  see  that  no  spoiled  cans  are 


THE  HYGIENE  OF  MOVING  TROOPS     113 

used.  If  this  be  done,  they  constitute  fairly  pleasant  and 
very  wholesome  food-supplies,  but  they  should  be  sup- 
plemented with  fresh  articles  when  these  are  obtainable. 
The  general  care  in  the  preparation  of  foods  that  has 
been  indicated  as  desirable  in  camps  should  be  exercised 
in  the  short  camps  made  by  marching  troops. 

The  government  provides  suitable  clothing  for  all 
varieties  of  climate  and  weather,  and  the  company  com- 
mander should  see  that  his  men  are  pro-  niothinff 
vided  with  the  proper  kinds  and  amounts  to 
meet  the  probable  needs  of  the  march.  Flannel  shirts 
should  be  worn  even  in  tropical  climates,  as  they  pre- 
vent too  rapid  cooling  of  the  body  and  afford  protection 
from  the  night  chill.  Blouses  or  coats  are  rather  an 
impediment  than  a  help  in  the  tropics,  if  flannel  shirts 
are  worn,  though  more  useful  and  comfortable  than  a 
sweater  in  cold  weather,  especially  cold,  windy  weather. 

The  poncho  should  always  be  carried  and  the  blanket 
nearly  always,  even  in  hot  seasons,  as  the  night  chill 
is  often  penetrating  and  is  accentuated  if  the  clothing 
or  the  ground  be  wet.  The  mosquito  net,  while  not  an 
article  of  clothing,  may  be  mentioned  here  as  most  im- 
portant in  tropical  countries,  or  hot  weather.  It  is  the 
soldier's  most  important  protection  against  yellow  fever, 
malaria,  and  dengue;  while  it  may  be  quite  as  efficient 
in  protecting  him  from  tick-bites,  from  the  flies  that 
infest  with  screw-worms,  from  poisonous  insects  and 
reptiles.  Its  use,  though  the  importance  of  it  has  long 
been  recognized,  is  apt  to  be  neglected  on  marches. 

It  is  not  considered  necessary  to  discuss  in  detail  the 
various  articles  and  kinds  of  clothing  to  be  worn,  but 
some  few  articles  need  discussion.  The  drill  regulations 
allow  the  marching  soldier  three  pairs  of  socks,  one  pair 


114    THE  RECRUIT  AND  HIS  ENVIRONMENT 

on  liis  feet,  one  in  his  blanket-roll,  and  one  in  his  surplus 
kit  on  the  company  wagon.  In  order  to  keep  his  feet  in 
good  condition  he  should  begin  each  day's  march  with 
clean  feet  in  clean  socks,  and  must  always  have  a  dry 
and  clean  pair  of  socks  for  emergencies,  such  as  the 
accidental  falling  into  mud-puddles  or  streams.  It  is 
therefore  necessary  that  he  should  wash  his  feet  and 
one  pair  of  socks  each  night,  and  the  company  com- 
mander should  make  sure  that  he  does  so,  and  that,  if 
possible,  he  then  has  facilities,  such  as  a  fire,  for  drying 
the  socks.  The  socks  should  not  only  be  clean  and  dry, 
but  they  should  fit  properly.  If  too  long,  they  fold  or 
wrinkle  and  make  pi*essure  or  rub.  If  too  short,  they 
cramp  the  toes  and  may  be  as  important  in  causing  or 
aggravating  corns,  bunions,  foot-cramp,  and  ingrowing 
toe-nails  as  poorly  fitting  shoes.  They  should  be  of  such 
weight  as  is  suited  to  the  individual  man,  in  general 
being  rather  light  for  foot-troops  so  as  not  to  cause 
excessive  sweating  or  burning  of  the  feet.  Any  disorders 
arising  from  the  use  of  improper  socks  or  from  other 
cause  should  at  once  be  reported  to  the  surgeon,  who, 
by  timely  advice  or  treatment,  may  be  able  to  avert 
lameness  or  disability. 

Shoes  likewise  are  frequent  causes  of  lameness,  and 
in  many  instances  the  company  officer  is  to  blame  for 
not  seeing  that  his  men  get  proper  sizes  and  fits.  At 
other  times  the  quartermaster's  department  is  at  fault 
in  not  having  proper  sizes  for  issue.  In  such  event  the 
man  chooses  a  shoe  of  improper  size,  or  buys  them  of 
improper  shape  and  material  from  civilian  dealers.  The 
footgear  of  the  army  has  improved  in  quality  of  late 
years,  however,  and  most  of  the  shoes  now  issued  are 
excellent,  both  in  shape  and  material.   A  proper  shoe 


THE  HYGIENE  OF  MOVING  TROOPS     115 

should  be  sufficiently  long  and  broad,  so  that  the  toes 
are  not  crowded  even  after  a  long  march.  It  should  not 
make  painful  pressure  on  any  place,  but  should  fit 
snugly  and  evenly  over  the  instep  and  about  the  heel, 
to  prevent  rubbing  or  forward  slipping  of  the  foot.  The 
heel  should  be  broad  and  low.  Two  pairs  of  shoes  are 
allowed,  one  pair  on  the  feet  and  one  pair  in  the  surplus 
kit.  If  practicable,  the  day's  march  should  always  be 
begun  in  a  clean  and  dry  pair,  and  it  is  therefore  im- 
portant that  a  part  of  each  evening's  work  should  be 
the  cleaning,  drying,  and  oiling  of  one  pair.  For  the 
last-named  purpose,  a  piece  of  fat  meat  will  answer  if 
other  oil  is  not  obtainable.  Shoes  left  wet  and  dirty 
soon  become  hard,  wrinkled,  and  uncomfortable,  and 
"  run  over  "  and  break  more  readily  than  those  kept 
clean  and  supple. 

Two  suits  of  underclothing  are  allowed,  one  on  the 
person  and  one  in  the  surplus  kit.  As  underclothing 
is  even  more  important  as  a  protection  from  dirt  than 
from  cold,  these  will  also  require  frequent  washing. 
Neglect  of  this  may  result  in  attacks  of  boils,  ringworms, 
and  other  skin  infections.  When  a  day  in  camp  permits 
it,  and  coffee  tins  or  other  receptacles  are  available  for 
the  purpose,  underclothing  should  be  boiled. 

The  towel,,  but  one  being  authorized,  will  require 
frequent  washing. 

For  general  purposes  and  use  in  all  climates,  the 
campaign  hat  is  very  satisfactory,  though  discomfort 
and  complaint  have  been  caused  by  the  stiff  brim  that 
has  been  used  for  some  time  past.  With  a  soft  brim  it 
is  unexcelled  for  general  use,  though  in  the  tropics 
a  cork  or  pith  helmet  and  in  arctic  weather  a  fur  cap 
excel  it  for  seasonal  wear. 


116    THE  RECRUIT  AND  HIS  ENVIRONMENT 

There  is  no  evidence  of  any  advantage  in  red  or 
orange  hat  linings. 

The  general  rules  for  camp  police  should  be  applied 
to  marches  as  far  as  practicable,  and  they  can  be  ap- 
plied  to  a  far  greater  extent  than  is  ordi- 
narily the  case.  In  order  to  do  this,  proper 
instructions  should  be  given  in  advance,  and  each  com- 
pany should  have,  as  in  camp,  at  least  one  man  on 
sanitary  police  duty,  whose  business  it  would  be  to  see 
to  the  proper  disposal  of  waste  matters,  to  prevent  the 
careless  and  indiscriminate  soiling  of  halting-places,  to 
assist  in  preventing  the  use  of  improper  water,  and  to 
do  such  other  work  of  a  similar  character  as  the  cir^ 
cumstances  necessitate  or  the  medical  officer  recom- 
mends. Men  should  not,  except  in  urgent  cases,  be 
allowed  to  fall  out  except  at  regular  halts.  If  the  halt 
is  a  short  one,  the  company  commander  indicates  to  the 
sanitary  soldier  a  suitable  spot  for  urine  and  feces.  The 
man  goes  to  that  spot  and  marks  it.  All  men  needing 
to  fall  out  go  there  and  use  the  place  indicated,  after- 
ward covering  their  dejecta  with  earth.  If  the  halt  is 
longer,  half  an  hour  or  more,  the  sanitary  soldier  re- 
pairs at  once  to  the  designated  spot  and  digs  a  shallow 
trench  for  feces  and  a  shallow  pit  for  urine.  All  men 
should  be  instructed  to  use  these  places  only,  and  the 
trench  and  pit  should  be  filled  in  again  before  the 
march  is  resumed.  In  case  a  man,  from  urgent  neces- 
sity, does  fall  out  on  the  march,  he  should  be  instructed 
to  cover  his  feces  with  earth,  using  his  bayonet,  if 
necessary,  for  the  purpose.  Similar  rules  should  apply 
to  men  on  outpost  or  picket  duty,  and  in  this  way 
much  may  be  done  to  prevent  the  surroundings  of  a 
camp  from  becoming  an  ill-smelling,  fly-breeding  nui- 


THE  HYGIENE  OF  MOVING  TROOPS     117 

sance.  Scraps  of  food,  greasy  papers,  and  other  articles 
thrown  away  by  the  men  at  the  halting-place  should 
be  thrown  into  one  pit  and  burned  or  buried. 

On  arrival  at  camp,  the  sanitary  soldier  should  im- 
mediately begin  shallow  trenches  in  a  proper  place 
selected  by  the  medical  officer,  and  men  should  be 
punished  for  urinating  or  defecating  elsewhere.  After 
that,  the  other  business  of  making  camp  may  proceed. 
Without  it,  the  camp  should  not  be  made,  as  its  site 
will  almost  certainly  be  defiled. 

In  bivouac,  or  while  actually  marching,  the  men 
should  take  all  possible  precautions  to  protect  them- 
selves from,  or  to  rid  themselves  of,  vermin  and  insects, 
and  in  warm  weather  the  use  of  the  mosquito  net  should 
not  be  neglected. 

The  hygiene  of  the  battlefield  has  been  largely  set 
forth  in  the  consideration  of  the  camp  and  the  march. 
All  the  general  principles  there  set  down     battle, 
hold  good  and  should  be  observed  as  far     ^.i  ^ 
as  possible.  Often,  however,  the  military     „  o->na 
necessities  allow  no  time  to  be  devoted  to 
sanitary  matters ;  but  even  so,  the  soldier  who  has  been 
well  trained  to  a  realization  of  the  importance  of  such 
matters  will  be  able  to  take  better  care  of  himself  and 
to  do  less  harm  to  his  comrades  than  the  man  not  so 
trained. 

The  man  going  into  battle  should,  if  possible,  ob- 
serve all  of  the  following  rules  in  addition  to  the  gen- 
eral care  outlined  above :  — 

1.  Make  sure  that  you  have  a  first-aid  packet,  that 
it  is  in  good  condition,  and  that  you  know  how  to 
use  it. 

2.  Have  your  cauteen  full  of  boiled  water. 


118    THE   RECRUIT  AND  HIS   ENVIRONMENT 

3.  Be  clean  in  person  and  clothing,  be  bathed,  and 
have  on  fresh  underclothing. 

4.  Have  your  bowels  and  bladder  empty. 

6.  Eat  only  good,  nourishing,  and  digestible  food. 

All  of  these  rules  have  an  important  hygienic  bear- 
ing in  case  he  should  be  wounded.  The  introduction  of 
the  first-aid  packet  in  its  present  form  was  one  of  the 
greatest  improvements  in  military  hygiene  ever  con- 
summated, and  it  has  prevented  an  immense  amount 
of  suffering,  mutilation,  and  death.  For  a  large  pro- 
portion of  wounds,  a  properly  applied  first-aid  dressing 
constitutes  the  most  important  part  of  the  treatment, 
and,  in  many  cases,  the  whole  of  it.  W  ith  such  a  dress- 
ing at  hand  and  a  knowledge  as  to  how  to  apply  it,  the 
use  of  water  on  wounds  is  very  rarely  necessary.  But 
if  water  is  used,  it  is  most  important  that  it  should  have 
been  boiled.  Otherwise  it  may  infect  the  wound  most 
seriously.  Cleanliness  of  person  and  clothing  are  very 
important  for  the  same  reason,  to  prevent  infections. 
Most  infections  of  wounds  are  caused  by  bacteria  de- 
rived from  the  skin  or  its  coverings,  and  by  simple 
cleanliness  of  these,  surgeons  are  daily  able  to,  and  do, 
make  extensive  wounds  that  heal  without  a  trace  of 
infection.  The  importance  of  having  the  bowels  and 
bladder  empty,  or  relatively  so,  lies  in  the  fact  that 
wounds  of  these  viscera  are  exceedingly  dangerous,  but 
that  the  danger  is  directly  lessened  with  the  chances  of 
excremental  soiling  of  the  tissues.  For  this  reason, 
eating,  drinking,  and  moving,  all  of  which  increase  or 
facilitate  the  escape  of  intestinal  or  bladder  contents, 
are  to  be  avoided  in  the  case  of  belly  wounds,  and  for 
the  man  so  wounded  we  may  formulate  another  rule : 

6.  If  wounded  in  the  belly,  lie  down  in  the  most 


THE  HYGIENE  OF  MOVING  TROOPS     119 

comfortable  position,  eat  nothing,  drink  little  or  no- 
thing, do  not  move,  do  not  get  excited  or  restless.  If 
overlooked  or  forgotten,  you  may  be  better  off  than  if 
foimd  and  transported. 

The  sanitary  disadvantages  under  which  men  travel 
on  our  army  transports  are  numerous,  but  they  are 
mostly  beyond  the  company  officer's  power 
to  remedy.  The  transport  regulations  pro-         .      ^ 
vide  for  such  sanitary  measures  and  daily  *^ 

inspections  as  would  seem  to  assure  good  conditions, 
and  the  conditions  are  such  that  with  the  aid  derived 
from  sea  air  and  changes  of  scene  the  health  of  the 
men  is  usually  well  preserved  or  improved.  Over-crowd- 
ing is  an  evil  frequently  encountered  on  transports, 
and  one  from  which  others  flow.  The  company  com- 
mander is  quite  powerless  to  prevent  this,  but  he 
should  lessen  the  evils  of  it  by  having  his  quarters  as 
freely  ventilated  as  possible,  having  them  policed  each 
day,  and  vacated  by  both  men  and  their  belongings 
when  opportunity  offers.  He  should  see  that  his  men 
bathe  frequently  and  have  frequent  changes  of  under- 
clothing, and  that  they  get  suitable  opportunities  for 
clothes- washing. 

Transports  are  not  infrequently  infested  with  bed- 
bugs. The  company  officer  can  only  partially  correct 
this  evil  by  the  police  and  cleanliness  of  his  quarters, 
and,  at  times,  by  bed-bug  hunts  and  the  use  of  insect- 
icides. In  Canal  Zone  barracks,  which  are  provided 
with  bunks  similar  to  those  on  transports,  bugs  are 
destroyed  by  boiling  the  canvas  and  its  stretcher  frame 
and  flaming  the  upright  supports  with  a  gasoline  torch. 

The  food  on  transports  is  usually  of  good  quality 
and  VQry  nourishing,  but  the  methods  of  cooking  and 


120    THE  RECRUIT  AND  HIS  ENVIRONMENT 

serving  it  are  almost  always  monotonous  and  unat- 
tractive, and  result  in  unnecessary  waste,  improper 
methods  of  eating,  and  some  disgust  with  the  food.  The 
company  officer  should  try  to  influence  these  condi- 
tions for  the  better,  so  far  as  he  can  do  so.  Owing  to 
the  long  confinement  in  exceedingly  narrow  limits  dur- 
ing the  trans-Pacific  voyage,  unremitting  attention  to 
all  sanitary  details  is  urgently  demanded.  All  cases  of 
sickness  or  disease  of  any  kind  should  be  reported  to 
the  surgeon  early,  in  order  that  he  may  isolate  conta- 
gious diseases,  as  well  as  give  treatment.  The  two  ills 
from  which  a  majority  of  men  suffer  are  sea-sickness 
and  constipation,  the  former  at  the  beginning  of  the 
voyage,  the  latter  throughout  it.  The  tendency  to  sea- 
sickness is  lessened  if  the  man  goes  aboard  the  boat  in 
good  general  condition,  with  his  bowels  cleaned  out  and 
his  system  free  from  the  poisons  produced  by  over- 
eating, alcoholism,  and  other  excesses.  Constipation 
should  be  prevented,  if  possible,  by  the  use  of  rather 
bulky  foods,  such  as  oatmeal,  fruits,  and  vegetables,  by 
daily  exercise  and  a  well-maintained  habit  of  visiting 
the  closet  regularly  and  making  the  effort  to  defecate. 
Under  varying  conditions,  troop  trains  may  be  com- 
posed of  any  kinds  of  cars  that  are  in  use.  The  gen- 

eral  principles  of  troop  hygiene  should  be 
.  *^  applied  as  far  as  practicable,  whatever  the 

accommodations.  The  most  common  faults 
in  troop  trains  in  time  of  peace  are  poor  policing  and 
dirty  cars,  and  an  insufficiency  of  water  for  drinking 
and  cleaning  purposes.  Both  of  these  faults  are  usu- 
ally attributable  to  the  railway  officials,  but  the  troops 
are  partly  to  blame  in  that  they  are  sometimes  care- 
less and  wasteful  of  the  water,  and  make  very  little 


THE  HYGIENE  OF  MOVING  TROOPS     121 

effort  to  keep  the  cars  clean.  The  company  commander 
can  therefore  partially  control  the  evils.  He  should  also 
make  it  his  particular  care  to  see  that  the  car  closets 
are  well  supplied  with  water  for  flushing  purposes,  and 
that  the  supply  is  replenished  as  opportunity  offers. 


CHAPTER  VII 

THE   HYGIENE   OF  HOT   AND  COLD   CLIMATES 

The  general  principles  of  hygiene  are  the  same  the 
world  over  and  may  be  applied  in  any  climate.  They 
aim  to  keep  the  body  strong,  sound,  free  from  infection, 
and  at  its  maximum  efficiency.  Inasmuch,  though,  as  the 
dangers  of  infection  as  well  as  of  injury  from  extremes 
of  temperature  are  somewhat  different  in  the  tropics 
and  the  arctics,  it  is  well  to  give  these  conditions  sepa- 
rate consideration. 

Hot  Countries 
The  danger  to  life  and  health  is  greater  in  nearly 
all  tropical  countries  than  in  those  that  are  temper- 
ate. This  is  due  to  a  number  of  causes,  among  which 
we  may  note  the  almost  total  neglect  or  ignorance  of 
sanitation  among  tropical  peoples,  the  high,  even,  and 
often  moist,  temperature  in  which  disease-producing 
organisms  flourish  and  multiply,  the  great  abundance 
and  variety  of  insect-life,  the  common  pollution  of 
water-supplies,  the  habits  of  dress,  and  the  heat  itself. 
It  is  sometimes  said  that  the  safest  procedure  in  matters 
of  hygiene  in  strange  countries  or  climates  is  to  con- 
form to  the  habits  of  the  natives,  but  this  is  often  a 
very  serious  error,  and  it  has  undoubtedly  cost  many 
lives.  It  is  faulty  habits  in  the  natives  that  help  to  keep 
alive,  in  the  tropics,  many  diseases  that  have  long  since 
almost  or  entirely  disappeared  from  temperate  climes, 
while  the  people  sicken  and  die  of  preventable  infec- 


HYGIENE  OF  HOT  AND  COLD  CLIMATES   123 

tious  diseases  in  far  greater  numbers  than  should  be 
the  case. 

The  native  of  the  tropics  is  very  apt  to  suffer  from 
water-borne  diseases,  and  cholera  and  dysentery,  al- 
though not  limited  to  tropical  climates,  are 
so  much  less  prevalent  elsewhere  as  to  be 
relatively  rare,  even  if  not  unknown.  The  native  is  in- 
fluenced in  his  choice  of  a  water-supply  by  convenience, 
superstition,  habit,  and  the  fact  that  his  ancestors  did 
certain  things,  but  not  often  by  sanitary  considerations. 
For  this  reason  he  suffers  from  the  diseases  mentioned, 
and  partly  for  this  reason  he  practically  always  harbors 
one  or  more  varieties  of  intestinal  worms.  The  only 
safe  rule  for  general  application  to  drinking-water  in 
the  tropics  is  that  it  should  be  sterilized  by  boiling, 
distillation,  filtration,  or  chemical  treatment.  But 
this  alone  is  not  sufficient.  The  water  must  be  kept 
sterile  until  consumed,  by  being  put  in  sterile  contain- 
ers and  closed  against  all  possible  contaminations.  Both 
Filipino  and  Chinese  servants  in  the  Philippines  are  so 
entirely  ignorant  of  the  very  meaning  of  sanitary  pre- 
cautions, that  they  are  continually  giiilty  of  such  action 
as  stoppering  bottles  of  distilled  water  with  corks  they 
have  held  in  their  mouths,  wiping  out  a  drinking-glass 
with  a  dirty  rag  or  paper  picked  from  the  floor,  drink- 
ing direct  from  bottles,  and  bottling  unboiled  water 
rather  than  take  the  trouble  of  boiling  it,  and  it  is  feared 
that  not  all  soldiers  are  free  from  some  of  these  faults. 

It  is  generally  asserted,  and  is  theoretically  true, 
that  less  food  is  required  in  the  tropics  than  in  colder 
climates,  and  that  the  fats  and  proteids  i^i     .«      , 
particular  should  be  considerably  reduced. 
This  may  be  admitted,  but  we  must  also  admit  that 


124    THE  RECRUIT  AND  HIS  ENVIRONMENT 

lifelong  habits,  exercise,  and  temperament  exert  an 
influence  that  cannot  be  ignored,  and  any  arbitrary 
attempt  to  put  American  soldiers,  especially  if  they  be 
doing  field-work,  on  a  ration  approaching  the  rice-and- 
fish  diet  on  which  many  natives  of  the  tropics  live, 
will  result  not  only  in  discontent,  but  also  in  impaired 
nutrition  and  in  clandestine  indulgence  in  food  or  drink 
of  improper  character.  The  present  army  ration  is 
thought  to  be  excellent  for  the  tropics,  as  for  home, 
provided  that  the  men  work  and  exercise  as  at  home. 
If  such  is  not  the  case,  the  ration  is  too  heavy  and 
should  be  reduced  as  indicated.  The  sugars  and  starches 
are  well  borne  in  the  tropics,  are  not  such  "  heating  " 
food  as  fat  and  proteid,  and  do  not  tend,  in  the  same 
way  and  same  degree,  to  cast  an  excessive  amount  of 
work  on  the  liver  and  kidneys.  Neither  do  they  offer 
opportunities  for  such  harmful  forms  of  intestinal  putre- 
faction. Organic  acids,  such  as  fruit- juices,  are  espe- 
cially valuable  and  important,  as  well  as  agreeable,  in 
the  tropics. 

Care  must  be  exercised  in  the  use  of  fresh  fruits  and 
green  vegetables,  not  because  they  are  in  themselves 
harmful,  but  because  they  are  apt  to  be  contaminated, 
from  unclean  water  or  from  fecal  manuring,  with  the 
parasites  causing  intestinal  diseases.  The  only  safe 
plan  in  using  them  in  countries  where  dysentery,  chol- 
era, and  intestinal  worms  abound  is  to  have  them 
sterilized :  the  green  vegetables  and  some  fruits  by 
cooking ;  bananas,  mangoes,  oranges,  and  similar  thick- 
skinned  fruits,  by  thorough  washing  in  boiled  water. 
A  large  part  of  the  food  consumed  by  white  people 
in  the  tropics  is  preserved  by  refrigeration  or  by  can- 
ning.  It  is  as  good  there  as  elsewhere,  but  is  apt  to 


HYGIENE  OF  HOT  AND  COLD  CLIMATES    125 

decompose  rapidly  after  exposure  to  the  ordinary  tem- 
perature and  atmospheric  conditions,  and  should  there- 
fore be  used  promptly  after  such  exposure. 

Owing  to  the  facility  with  which  potatoes  and  similar 
vegetables  spoil,  the  tropical  resident  should  early  ac- 
custom himself  to  the  use  of  rice,  yams,  and  similar 
products.  The  use  of  condiments  and  spices  is  gener- 
ally more  liberal  in  the  tropics  than  elsewhere.  This 
is,  partly  at  least,  a  matter  of  custom,  but  it  may  have 
a  physiological  basis  in  that  these  articles  are  stimu- 
lant to  the  alimentary  tract.  They  are  not  known  to 
do  harm. 

Alcohol  is  quite  as  much  abused  by  northern  peoples 
in  the  tropics  as  in  their  own  homes,  or  more  so.  In 
real  moderation,  that  is,  in  the  amounts 
that  can  be  completely  oxidized  in  the  body  •'^^conoi 
and  used  as  food,  it  is  not  known  tiiat  alcohol  is  more 
harmful  in  the  tropics  than  elsewhere.  In  greater 
amount  it  is  so,  for  the  reason  that  alcohol  in  excess  is 
in  all  climates  an  irritant  to  the  liver,  and  in  the  tropics 
the  liver  is  already  hard-worked,  irritated,  "  sluggish," 
and  subject  to  congestions, — conditions  aggravated  by 
the  irritation  from  the  alcohol.  Like  the  proteins  and 
fats  it  does  less  harm  if  plenty  of  exercise  is  taken  to 
promote  its  oxidation  and  the  elimination  of  the  com- 
bustion-products. As  in  other  climates,  its  use  is  only 
infrequently  indicated,  and  abstinence  from  it  is  advis- 
able. Its  very  general,  and  often  excessive,  use  among 
soldiers  proceeds  not  so  much  from  any  needs  of  the 
system  as  from  idleness,  vacancy  of  mind,  evil  exam- 
ples or  careless  associations,  laxity  of  public  opinion 
on  such  matters,  and  absence  of  such  restraining  influ- 
ences as  home-life  and  respectable  female  society.   It 


126    THE   RECRUIT  AND  HIS   ENVIRONMENT 

would  therefore  seem  that  the  company  officer  can  best 
combat  the  evil  by  attention  to  these  points.  Heat- 
stroke and  heat-exhaustion  are  much  more  apt  to  occur 
in  a  man  who  is  drinking,  and  to  be  more  severe  when 
they  do  occur.  All  drinking  to  excess  is  debilitating 
and  probably  lessens  the  resistance  to  infections.  Re- 
currences of  malaria  and  dysentery  are  not  infrequently 
brought  on  by  drinking-bouts  or  sprees.  Alcohol  also 
predisposes  in  more  indirect  ways  to  disease-infections, 
as  by  rendering  a  man  neglectful  of  the  quality  of  his 
food  or  the  use  of  his  mosquito  net,  and  because  he 
may  use  impure  water  with  his  drink,  erroneously 
trusting  to  the  alcohol  to  sterilize  it. 

In  general  terms,  the  dress  should  be  adapted  to  the 
climate  and  to  insure  comfort  and  protection.  The 
clothing  issued  to  the  army  fulfills  these 
°  requirements,  allowing  variations  in  the 
underclothing  to  suit  individual  tastes  and  require- 
ments. The  cotton  service  cloth  for  outer  dress  is 
cheap,  strong,  durable,  fairly  cool,  and  easily  washed. 
The  flannel  shirt  for  the  field  and  those  of  cotton  for 
barracks  meet  the  requirements.  British  writers  lay 
some  emphasis  on  the  desijability  of  always  wearing 
woolen  clothing  in  order  to  protect  from  chill,  and 
much  has  been  said  as  to  the  value  of  the  woolen 
belly-band  or  abdominal  binder.  The  writer's  personal 
experience,  and  observations  as  to  the  general  American 
experience,  in  the  tropics  do  not  indicate  that  this  is  a 
rule  of  general  application.  As  stated  before,  most 
tropical  diseases  are  infectious  in  nature,  and  if  proper 
precautions  be  taken  to  avoid  the  infections,  it  is  not 
thought  that  the  discomfort  produced  by  too  great 
warmth  of  body,  excessive  perspiration,  and  prickly 


HYGIENE  OF   HOT  AND  COLD  CLIMATES    127 

heat  is  apt  to  offer  additional  protection.  In  the  field, 
where  the  chill  of  night  air  is  more  keenly  felt  and 
where  wetting  may  occur  from  rain  or  from  fording 
streams,  the  flannel  shirt  should  be  worn,  and  it  and 
the  blanket  meet  the  requirements.  There  is  no  objec- 
tion to  the  use  of  light  flannels  by  men  who  find  them 
comfortable,  while  in  the  cold  season  and  in  high  lands, 
as  at  Baguio  in  Luzon,  they  may  be  much  needed ;  but 
for  most  of  the  service  to  which  our  men  have  been 
subjected  in  the  tropics  they  are  a  source  of  harm 
rather  than  of  good.  Light-weight  cotton  undershirts, 
with  short  sleeves,  and  muslin  drawers  not  coming 
much  below  the  knees  are  preferred.  The  clothing 
worn  in  the  tropics  requires  frequent  washing  and  fre- 
quent changing,  and  a  good-sized  laundry  bill  is  a 
necessity.  The  clothing  is  usually  sun-dried,  and  that 
is  an  important  aid  in  destroying  germs  on  it.  Most 
native  wash-men  do  not  boil  it,  but,  if  feasible,  they 
should  be  required  to  do  so. 

The  campaign  hat,  as  previously  stated,  is  an  excel- 
lent article  for  field  use,  but  it  should  be  well  ventilated 
by  openings  in  the  sides,  and  should  be  worn  in  such  a 
manner  as  to  preserve  a  large  air-space  above  the  head. 

The  service  cap  offers  very  little  protection  from  either 
heat  or  light,  and  is  an  unsuitable  form  of  headgear  for 
the  tropics.  It  should  be  superseded  for  garrison  use 
there  by  the  campaign  hat  or  a  helmet,  the  latter  of  pith 
or  cork  and  with  a  ventilated  sweatband  and  crown. 
Much  has  been  said  and  written  about  the  value  of  pro- 
tection from  the  actinic  or  invisible  rays  of  the  sun,  and 
helmets  with  an  interlining  of  metal  foil,  and  hat  lin- 
ings, underclothing,  and  spine-protectors  of  black,  red, 
or  orange  material  have  been  advocated  as  means  of 


128    THE  RECRUIT  AND  HIS  ENVIRONMENT 

protection  from  them.  Observation  and  experiment 
indicate  that  the  main  causes,  other  than  infectious 
diseases,  of  tropical  invalidism  and  discomfort  are  heat 
and  humidity,  and  that,  with  due  care  in  regard  to  these, 
the  effects  of  actinic  rays  are  practically  negligible. 
In  fact,  it  is  the  writer's  opinion  and  observation  that 
persons  much  in  the  sun  are  apt  to  fare  better,  except 
as  regards  infectious  diseases,  than  those  who  remain 
much  indoors,  possibly  because  the  former  get  more 
exercise. 

The  evil  effects  ascribed  to  the  actinic  rays  are  prin- 
cipally those  manifesting  themselves  as  functional  nerv- 
ous disorders.  Such  disorders  are  notoriously  hard  to 
trace  to  a  definite  cause,  and,  on  the  other  hand,  the 
sufferers  from  them  are  the  most  favorable  subjects  for 
treatment  by  mental  suggestion.  Therefore,  the  fact 
that  a  number  of  such  sufferers  are  benefited  by  the 
use  of  red  underclothing  is  not  conclusive  evidence 
that  their  ills  were  caused  by  actinic  rays. 

Shoes  should  always  be  worn  in  the  tropics  as  a  pro- 
tection against  infections.  Comfort  and  fit  should  be 
considered  as  elsewhere,  but  because  it  is  comfortable 
to  go  barefooted  is  not  sufficient  reason  for  doing  it. 
One  of  the  greatest  causes  of  sickness  and  debility  in 
the  tropics  is  the  hookworm,  and  as  it  usually  gains 
entrance  to  the  body  through  the  skin  of  the  feet,  the 
general  use  of  shoes  is  looked  upon  as  an  important 
method  of  protection  against  it.  Plague  infection  usu- 
ally occurs  through  flea-bites  on  the  feet  and  legs.  Other 
infections  occur  in  the  same  way ;  and  the  subject  will 
be  discussed  at  greater  length  in  another  chapter.  Shoes 
and  leggings  also  protect  against  leeches,  ticks,  mosqui- 
toes, and  other  insects. 


HYGIENE  OF  HOT  AND  COLD  CLIMATES    129 

Because  of  the  heat,  the  relative  cheapness  of  native 

servants,  and  his  comparative  wealth,  the  American  is 

apt  to  nefflect  outdoor  exercise  in  the  trop-     _ 

•       T.  11111  Exercise 

les.  It  IS  very  important  that  he  should  not 

do  this,  as  abundant  experience  has  shown  that  exercise 
lessens  the  liability  to  the  nervous  breakdowns  that  con- 
stitute one  of  the  chief  causes  of  invaliding  from  the 
tropics.  It  is  desirable  that  the  glare  and  heat  of  midday 
be  avoided  as  times  for  such  exercise,  the  early  morning  or 
the  evening  being  preferred.  The  exercise  should  be 
incidental  to  interesting  work  or  play.  Tennis,  polo, 
football,  horseback-riding,  and  hunting  are  excellent 
forms.  Marching  is  also  good  if  the  men  are  interested 
and  cheerful.  After  the  exercise,  which  should  be  suffi- 
ciently violent  to  produce  a  good  sweat,  the  body  should 
be  bathed,  well  rubbed  down,  and  dry  clothing  put  on. 
Swimming  is  also  a  good  form  of  exercise  and  one  that 
should  be  encouraged,  as  every  soldier  should  be  a  good 
swimmer. 

With  proper  precautions  as  to  exposure  to  the  sun, 
the  prevention  of  chill  from  wet  clothing,  and  the 
avoidance  of  great  fatigue,  it  is  thought  that  exercise 
will  do  only  good.  Many  white  men  in  the  tropics  suffer 
from  lack  of  it,  very  few,  and  they  are  usually  persons 
already  diseased,  from  excess.  Its  value  lies  in  the  pro- 
motion of  the  active  functioning  of  the  skin,  liver,  and 
other  organs  of  waste  elimination,  and  the  resulting 
improved  nervous  control,  rather  than  in  increase  of 
muscular  strength.  Without  exercise,  alcohol,  tobacco, 
and  excesses  in  food  are  all  doubly  harmful. 

Because  of  the  freer  perspiration  and  the  greater  lia- 
bility to  skin  diseases  in  the  tropics,  more  frequent 
baths  and  changes  of  clothing  are  necessary  than  in 


130    THE  RECRUIT  AND  HIS  ENVIRONMENT 

temperate  regions.  The  bath  water  should  not  be  suffi- 
ciently cold  to  produce  shock  or  chill,  but  as  such  water 
cannot  usually  be  obtained  in  the  tropics, 
°  that  feature  need  not  require  much  con- 
sideration. Persons  who  have  suffered  from  malaria  or 
dysentery  or  other  intestinal  troubles  should  use  tepid 
or  warm  water.  It  should  be  remembered  that  typhoid, 
dysentery,  cholera,  and  certain  infestations  with  animal 
parasites  may  be  contracted  by  bathing  in  polluted 
streams  or  ponds,  and  such  places  should  therefore  be 
avoided.  Whatever  the  source  of  the  water,  care  should 
be  taken  that  it  does  not  get  into  the  mouth  and  so 
carry  infection.  After  the  bath  the  body  should  be 
thoroughly  dried,  particular  attention  being  paid  to  the 
arm-pits,  crotch,  and  groins,  and,  if  these  parts  sweat 
profusely,  it  is  well  to  dabble  them  with  some  antisep- 
tic solution  and  then  dry  them  again,  after  which  they 
may  be  dusted  with  talcum  powder.  Fresh  and  dry 
underclothing  must  be  then  donned.  If  prickly-heat 
eruptions  are  present  or  appear  easily,  a  weak  formalin 
solution,  about  one  teaspoonful  of  formalin  to  a  pint  or 
a  quart  of  water,  may  be  used  to  sponge  the  body  after 
it  is  washed  and  before  drying.  It  is  thought  that  the 
measures  here  advised  are  as  good  as  are  known  for 
the  prevention  of  the  prickly  heat,  small  boils,  chafing, 
and  "  dhobie  itch  "  or  ringworms  that  cause  so  much 
annoyance  and  irritation  in  the  tropics.  In  addition,  it 
should  be  remembered  that  some  of  these  affections 
are  contagious,  and  contact  with  persons  having  them 
should  be  avoided.  Soldiers  occasionally  borrow  articles 
of  clothing  from  one  another,  and  that  is  another 
method  of  spreading  skin  diseases.  In  Japan  it  is  still 
a  rather  common  custom  for  many  people  to  bathe  in 


HYGIENE  OF  HOT  AND  COLD  CLIMATES    131 

the  same  tub  or  tankful  of  water,  and  that  probably 
accounts  for  much  of  the  abundant  skin  disease  seen 
in  that  country.  Such  a  practice,  though  economical  of 
fuel  and  water,  is  to  be  avoided. 

The  heat,  the  bright  light,  the  new  and  strange  en- 
vironment, the  native  habits  of  both  dress  and  conduct, 
unite  to  stimulate  and  excite  the  sexual  de-  ^ 
sires  of  the  new-comer  in  the  tropics,  while 
his  money  and  the  native  habits,  poverty,  ^° 
and  views  of  morality,  constitute  a  set  of  circumstances 
enabling  him  to  gratify  them.  In  consequence  he  is  apt 
to  indulge  in  such  sexual  excesses  as  impair  his  nervous 
control,  unless,  as  is  frequently  the  case,  he  is  soon  or 
often  checked  by  venereal  disease.  Later,  when  he  be- 
comes debilitated  by  his  excesses  or  by  other  causes, 
his  sexual  vigor  fails  and  he  begins  to  worry  about 
that,  thus  aggravating  and  accentuating  his  trouble. 
Nothing  that  is  equally  harmless  so  profoundly  affects 
the  mind  of  the  average  young  man  as  the  loss,  even 
though  it  be  temporary,  of  his  sexual  vigor,  and  nothing 
so  prolongs  and  aggravates  that  loss  as  continual  brood- 
ing over  it ;  so  in  this  combination  we  have  the  making 
of  neurasthenia  and  melancholia.  Each  man  should 
know  that  his  sexual  needs  are  not  greater  in  the 
tropics  than  elsewhere,  that  sexual  or  other  excesses 
may  bring  about  nervous  exhaustion  and  temporary 
loss  of  sexual  power,  and  that  the  best  rules  in  the 
tropics,  as  elsewhere,  are:  1.  Sexual  continence;  2. 
Avoidance  of  obscenity  and  indecency ;  3.  Cleanliness 
of  the  genitals ;  4.  Complete  avoidance  of  thought  or 
handling  of  them,  except  for  legitimate  and  proper 
purposes. 

The  necessity  for  thorough  policing  and  cleanliness 


132    THE  RECRUIT  AND  HIS   ENVIRONMENT 

of  houses  and  grounds  is  even  more  important  in  the 

tropics  than  elsewhere,  because    of  the  greater  prev- 

alence    of  vermin   and    of    vermin -borne 

diseases.    Malaria,  yellow  fever,  dengue, 

..         plague,  and   other  insect-borne   diseases, 

occur  principally  in  the  tropics,  and  are 

best  avoided  by  such  methods  of  policing 

as  do  away  with  the  feeding  or  breeding  places  of  the 

insects  carrying  them.    In  addition,  roaches  and  ants 

abound  in  numbers  and  with  a  persistency  not  seen 

elsewhere,  and,  as  they  run  impartially  in  water-closets 

and  food-chests,  it  is  easily  conceivable  that  they  may 

transmit  disease.    Rate  and  mice  constitute  not  only 

an  annoyance  but  also  a  great  and  positive  source  of 

danger,  because  it  is  among  them  that  epidemics  of 

plague  begin,  and  it  is  from  such  rat  epidemics  that 

those  among  people  take  their  origin.    Parasitic  skin 

affections  prevail  very  widely  among  persons,  domestic 

animals,  and  fowls,  and  it  is  partly  by  cleanliness  of 

habitation  that  we  escape  them. 

All  the  usual  sanitary  precautions  as  to  cleanliness, 
plumbing,  and  good  policing  are  to  be  observed  in  the 
tropics  as  elsewhere  ;  but  additional  care  must  be  given 
to  all  standing  water  both  inside  the  house  and  out,  to 
prevent  mosquitoes  breeding  in  it.  Such  collections 
should  not  be  allowed  if  they  can  be  avoided.  If  allowed 
to  exist,  the  water  should  be  completely  emptied  and 
renewed  once  in  four  or  five  days  at  most,  or  should  be 
kept  covered  with  a  film  of  mineral  oil,  which  can  be 
renewed  at  like  intervals.  Ponds  or  other  large  collec- 
tions should  be  stocked  with  fish,  and  the  general  pre- 
cautions against  mosquitoes,  to  be  outlined  later,  should 
be  observed.    Mosquito-proof  houses  have  proved  of 


HYGIENE  OF  HOT  AND  COLD  CLIMATES    133 

great  benefit  in  the  prevention  of  mosquito-bome  dis- 
eases in  the  Canal  Zone,  as  well  as  adding  very  greatly 
to  the  comfort  of  life  there.  That  they  are  not  univer- 
sally used  in  malarious  countries  is  a  misfortune  where 
it  is  not  a  reproach. 

Very  Cold  Climates 

The  principal  sanitary  dangers  menacing  the  dwellers 
in  very  cold  climates,  aside  from  lack  of  food  and  other 
things  outside  of  our  present  consideration,  arise  from 
exposure  to  cold,  resulting  in  frost-bite  or  freezing,  from 
poor  ventilation,  from  too  intimate  association  with 
diseased  persons  or  animals,  from  improper  food  or 
lack  of  fresh  food.  Infectious  diseases  are  less  numerous 
than  elsewhere,  as  their  germs  do  not  find  such  favor- 
able surroundings  in  which  to  grow,  and  there  are  fewer 
persons  to  harbor  and  distribute  them. 

The  outdoor  air  of  arctic  regions  is  purer  and  freer 
from  disease-producing  organisms  than  that  of  other 
regions.  Man-polluted  air  is  as  dangerous 
there,  however,  as  elsewhere.  As  ventilation 
and  heating  are,  from  a  sanitary  standpoint,  insepara- 
ble, and,  as  free  ventilation  makes  heating  more  diffi- 
cult because  of  the  greater  volume  of  air  that  must  be 
warmed,  it  may  be  understood  at  once  that  the  natural 
tendency  in  an  arctic  climate  is  to  have  poor  ventilation. 
Every  increase  in  ventilation  lets  in  cold  and  allows 
heat  to  escape,  and  the  discomfort  of  this  is  more 
acutely  and  keenly  felt  than  that  due  to  foul  air ;  so  the 
effort  to  keep  warm  may  cause  the  air  to  become  vile. 
As  animal  heat  helps  materially  to  warm  a  crowded 
space,  and  as  crowding  lessens  the  consumption  of  fuel, 
man  and  dogs,  sick  and  well,  are  thrown  into  close  con- 


134    THE   RECRUIT  AND  HIS  ENVIRONMENT 

tact.  If  one  man  in  a  crowded,  ill- ventilated  room  has 
tuberculosis,  diphtheria,  tonsillitis,  measles,  smallpox, 
or  other  contagious  malady,  the  contagium  or  poison  is 
so  concentrated  as  to  make  all  present  unusually  liable 
to  contract  the  disease. 

Ventilation,  therefore,  should  be  as  free  as  possible, 
care  being  taken  to  warm  the  incoming  air,  as  by  al- 
lowing the  air  to  enter  through  a  tube  or  tunnel  open- 
ing under  or  about  the  stove.  Should  the  air  enter 
unwarmed  it  will  cause  such  condensation  of  moisture 
as  to  make  the  hut  damp.  Crowding  should  be  avoided, 
and  as  much  time  as  possible  be  spent  in  the  open. 
Particularly  should  intimate  association  in  crowded 
rooms  with  sick  persons  be  avoided.  The  intimate  con- 
tact with  sick  and  with  animals  is  also  productive  of 
disease  in  other  ways  than  that  indicated  above.  A 
man  having  gonorrhcea  or  syphilis  is  in  such  circum- 
stances much  more  apt  to  infect  innocently  and  un- 
knowingly those  about  him  than  he  would  be  under 
other  conditions.  Echinococcus  disease,  due  to  infesta- 
tion with  a  certain  dog  tapeworm,  is  almost  limited  to 
persons  brought  into  such  intimate  contact  with  dogs 
as  is  here  mentioned.  Cleanliness  is  almost  impossible 
under  such  conditions,  and  wounds  are  thereby  very  apt 
to  become  infected. 

A  pure  water-supply  is  not  such  a  rarity  in  the  arctics 
as  in  the  tropics,  both  because  pathogenic  germs  do  not 

^  _.,_,,  flourish  in  arctic  temperatures  and  because 

vvater  ■,  c      u 

men  are  less  numerous  as  sources  oi  pollu- 
tion. The  danger  of  pollution  of  a  supply  is  greatest  in 
the  spring  and  summer,  when  melting  snow  may  wash 
into  it  the  excrement  that  was  scattered  in  the  neigh- 
borhood during  the  very  cold  weather.   Excrement  is 


HYGIENE  OF  HOT  AND  COLD  CLIMATES     135 

apt  to  be  so  scattered,  for  the  reasons  that  other  disposal 
may  be  more  troublesome  and  that  snow  and  freezing 
prevent  its  constituting  a  nuisance  to  the  nose  and  eyes. 
Especial  care  should  be  exercised  to  prevent  anything 
of  the  kind,  and  drinking  water  should  always  be  taken 
from  points  above  any  possibility  of  such  contamination. 
Attempts  should  not  be  made,  particularly  on  marches, 
to  quench  thirst  with  snow  or  ice,  as  they  detract  from 
the  local  and  general  heat  of  the  body,  and  are  liable 
to  iri'itate  the  mouth  and  throat.  Snow  and  ice  may  fur- 
nish the  water-supply,  but  they  must  be  melted  and  the 
water  heated,  when  it  may  be  profitably  used  in  making 
tea,  which  is  then  refreshing,  comforting,  and  stimulat- 
ing, and  adds  to  the  warmth  of  the  body. 

The  food -supply  of  the  arctics  consists  largely  of 
canned  goods,  and  may  be  quite  generous.  Every  effort 
should  be  made  to  supplement  that  diet 
with  fresh  articles,  whether  of  animal  or 
vegetable  origin,  as  scurvy  is  otherwise  apt  to  make  its 
appearance.  This  disease  is  due  to  the  deficiency  of 
some  principle  or  "  vitamine  "  contained  in  both  meats 
and  vegetables,  which  is  destroyed  by  overheating,  by 
long  storage  or  by  ripening  and  drying  of  the  vegeta- 
bles. For  instance,  it  can  be  caused  in  guinea  pigs  by 
a  diet  of  bread  and  dried  mongo  beans,  while  a  diet  of 
bread  and  sprouted  mongo  beans  protects  them  from  it. 
The  Scott  Antarctic  expedition  avoided  scurvy  by  the 
abundant  use  of  the  fresh  or  frozen  meat  of  gulls,  pen- 
guins, and  seals,  and  the  surgeon  especially  praises  seal 
meat  as  an  antiscorbutic. 

Because  of  the  necessity  of  greater  bodily  heat-pro- 
duction in  the  arctics,  more  food  is  required,  and,  as 
meat  and  fat  give  rise  to  more  heat  during  their  oxi- 


136    THE   RECRUIT  AND   HIS   ENVIRONMENT 

dation,  and  as  they  are  also  more  readily  obtained,  it  is 
in  them  that  the  increase  should  be  made.  This  need 
is  recognized  by  the  government,  and  is  met  by  an 
increase  in  the  ration  for  troops  serving  in  Alaska. 
Where  game  or  fish  are  obtainable  they  should  be  used 
to  supplement  the  ration.  The  methods  of  preparing 
the  food  are  not  essentially  different  from  those  used 
elsewhere.  Foods  should  be  served  hot,  and  the  heat 
of  the  body  so  conserved. 

Alcohol  should  not  be  used  in  the  arctics  except  as  a 
drug,  as  it  increases  heat-radiation  and  loss.  Particular 
care  should  be  takeu  that  it  is  not  used 
during  the  period  of  exposure  to  cold,  as 
that  is  the  time  when  loss  of  heat  is  to  be  especially 
avoided.  If  used  at  all,  it  should  be  after  the  period  of 
exposure,  when  the  body  is  chilled  and  the  surround- 
ings warm  and  comfortable.  In  such  circumstances  it 
may  be  of  considerable  value,  but  its  routine  use  should 
not  be  practiced. 

Fur,  feathers,  and  wool  as  conservators  of  heat,  and 
canvas  and  leather  as  protection  from  wind,  constitute 
the  main  clothing-supply  and  bodily  pro- 
°  tection  in  the  arctics.  Fur,  leather,  and 
canvas,  with  the  exception  of  shoes,  are  for  use  out-of- 
doors  only,  wool  for  general  wear  both  indoors  and  out, 
while  feathers  or  down  are  used  in  bedding.  Extreme 
cold  is  nearly  always  dry,  and  may  therefore  cause  less 
suffering  than  higher  temperatures  when  the  air  is 
moist.  Wind  of  course  greatly  increases  the  suffering 
and  the  danger  from  either  dry  or  wet  cold.  The  reason 
that  fur,  feathers,  and  wool  make  such  warm  clothing  is 
twofohl ;  they  are  themselves  poor  conductors  of  heat, 
and  they  contain  in  their  interstices  a  large  amount  of 


HYGIENE  OF  HOT  AND  COLD  CLIMATES    137 

air,  another  poor  conductor.  For  the  latter  reason  a 
multiplicity  of  light  garments  is  warmer  than  the  same 
amount  of  material  woven  into  one  heavy  garment,  and 
cotton  or  silk  wadding  may  be  used  also  with  good  re- 
sults. It  is  because  they  prevent  the  displacement  of 
the  warmed  non-conducting  layer  of  air  within  the 
clothing  that  leather  or  close-woven  canvas  affords  such 
excellent  protection  against  wind. 

Fur  caps  and  gloves,  blanket-lined  canvas  boots,  can- 
vas overcoats  lined  with  blanket  or  sheepskin,  woolen 
outer  and  under  clothing,  woolen  socks,  oiled  shoes,  felt 
overshoes,  and  canvas  leggings  are  issued  for  very  cold 
service,  and  in  a  few  far  northern  posts  buffalo  coats  are 
furnished  for  use  by  men  on  guard.  By  proper  use,  these 
articles  can  be  made  to  furnish  adequate  protection 
against  any  cold  that  is  likely  to  be  encountered.  The 
parts  most  apt  to  suffer  from  cold  are  those  most  ex- 
posed and  having  the  weakest  circulation,  such  as  the 
nose  and  cheeks,  the  ears,  hands,  and  feet.  The  fur  cap 
protects  the  head  and  ears,  but  not  the  neck  and  face. 
It  should  therefore  be  used  with  the  overcoat  collar 
turned  up,  or  with  the  hood  of  the  coat,  in  very  cold 
weather.  The  blanket-lined  canvas  hood  covers  the  neck 
and  part  of  the  face  and  therefore  affords  better  pro- 
tection. A  veil  or  a  strip  of  cloth  may  also  be  worn 
across  the  lower  part  of  the  face  if  necessary.  The  fur 
gloves  adequately  protect  the  hands  except  in  the  most 
extreme  cold  or  in  cases  of  long  exposure.  If  necessary, 
woolen  gloves  may  be  worn  beneath  them.  When,  in 
spite  of  them,  the  hands  become  numb  and  cold,  they 
should  be  beaten  or  exercised  to  warm  them.  For  work 
not  requiring  the  use  of  individual  fingers,  woolen  mit- 
tens under  canvas  afford  good  protection  for  the  hands. 


138    THE  RECRUIT  AND  HIS   ENVIRONMENT 

Care  should  be  exercised  about  removing  the  warm 
hand  from  its  glove  to  do  delicate  work  in  the  cold.  A 
soldier  has  been  known  to  have  both  hands  frost-bitten 
because  he  removed  his  gloves  in  the  wind  and  in  a  tem- 
perature of  40°  below  zero  F.  long  enough  to  adjust  his 
saddle.  The  feet  are  easily  kept  warm  during  walking 
if  the  government  issues  of  footwear  are  properly  used ; 
but  when  men  are  riding  and  not  using  the  feet,  or  when 
snowshoeing  and  the  feet  are  bound  so  tightly  that  the 
circulation  is  interfered  with,  the  problem  is  more  diffi- 
cult. Except  in  wet  weather,  the  foot-covering  should 
not  be  impermeable,  as  the  feet  when  comfortably 
warm  are  apt  to  perspire,  and  such  a  covering  as  a 
rubber  shoe  causes  the  perspiration  to  condense  against 
it  and  to  be  frozen  there,  so  that  the  foot  is  almost  or 
actually  in  contact  with  ice.  An  oiled  shoe  is  less  ob- 
jectionable, as  it  does  permit  the  vapor  to  escape,  in 
part  at  least.  In  very  dry  cold,  however,  a  felt  shoe,  or 
two  or  more  pairs  of  woolen  socks  with  canvas  or  soft 
leather  moccasins,  may  be  better  still.  Fur-lined  boots 
or  stockings  are  very  warm.  Surgeon  Atkinson,  of  the 
Scott  expedition,  says :  "  It  was  essential  each  night  on 
camping  to  change  the  footgear  immediately,  the  socks 
having  become  saturated  with  perspiration.  Special 
socks  of  very  thick  woolen  texture  were  kept  for  sleep- 
ing in,  and  they  remained  practically  dry.  Over  them 
was  worn  a  loose  fitting  bag  of  some  fur.  On  changing 
the  socks  they  were  pinned  together  with  a  safety  pin 
and  hung  outside.  If  there  was  a  good  sun,  by  next 
morning  they  were  completely  dry  and  comfortable." 
The  remainder  of  this  chapter  is  made  up  of  extracts 
from  Surjjeon  Atkinson's  account  of  the  antarctic  ex* 
periences  of  the  Soott  expedition. 


HYGIENE  OF  HOT  AND  COLD  CLIMATES    139 

"  Frost-bite  varied  in  degree  from  the  loss  of  a  super- 
ficial patch  of  skin  to  the  loss  of  parts  of     _       ^ 
limbs.''  ^'°«*" 

"  Frost-hites  of  First  Degree.  —  In  the 
open,  it  was  quite  a  common  and  even  laughable  ex- 
perience to  see  one's  companion's  nose  or  cheek  with  a 
patch  of  white  upon  it.  He,  at  the  time,  was  quite  un- 
conscious that  anything  was  wrong.  When  warned,  he 
removed  the  warm  can  from  his  mit  and  placed  it  upon 
the  offending  part.  At  the  same  time,  if  there  was  any 
wind,  he  would  turn  away  from  it.  After  a  minute  or 
so,  with  a  slight  tingling  sensation,  the  circulation  re- 
turned to  the  part,  and  in  the  course  of  a  day  or  so  there 
was  a  very  small  loss  of  quite  superficial  skin.  Parts 
which  had  been  attacked  by  frost-bite  became  necessa- 
rily more  subject  and  also,  luckily,  gave  warning.  If  a 
wind  sprang  up,  one  felt  a  sting  like  that  of  a  bee,  and 
knew  immediately  that  the  nose  or  cheek  was  attacked, 
and  took  measures  to  bring  the  circulation  back." 

"  Frost-bites  of  Second  Degree.  — Frost-bite  of  the 
second  degree  caused  blisters,  varjdng  depths  of  sub- 
stance being  implicated.  It  was  quite  common  after  any 
cold  sledging  trip  for  one's  fingers  to  be  bulbous  at  the 
end.  This  was  due  to  blisters  of  varying  sizes,  and  was 
caused  by  exposure  to  cold,  and  also  by  handling  cold 
metal  objects,  like  the  cooker  and  Primus.  These  blis- 
ters were  of  no  importance,  and  on  return  they  were 
pricked  ;  after  some  time  the  skin  was  replaced  and  the 
fingers  became  normal  again.  .  .  .  Another  effect  of 
continually  touching  cold  metal  objects  was  that  the 
fingers  never  quite  reached  the  stage  of  blistering,  but 
the  skin  became  hard  and  thickened,  so  much  so  that 
one  was  unable  to  appreciate  such  an  object  as  a  match 


140    THE   RECRUIT  AND  HIS  ENVIRONMENT 

between  the  fingers.  The  hardened  skin  always  peeled 
off  after  we  had  been  back  in  the  hut  for  a  time." 

"  Frost-bites  of  Third  Degree.  —  This  degree,  be- 
sides causing  blisters,  caused  actual  loss  of  substance 
by  gangrene.  After  exposure  the  onset  of  gangrene 
came  on  at  a  varying  period.  It  was  never  immediate, 
and  varied  from  a  fortnight  to  three  weeks.  The  blister 
contained  an  evil-smelling,  sanguineous  fluid,  and  be- 
neath it  was  a  dark,  f ungating  patch.  A  line  of  de- 
marcation formed  after  a  varying  period,  and  then 
sloughing  of  the  affected  part  followed.  .  .  .  The  only 
treatment  that  the  majority  of  frost-bites  needed  was 
the  application  of  a  warm  hand  to  the  affected  part. 
The  application  of  snow  is  probably  of  use  in  temperate 
climates,  but  where  the  snow  is  at  the  same  temperature 
as  the  air  it  is  impossible  to  do  this.  Also,  the  snow  in 
the  Antarctic  is  composed  of  hard,  sugary  grains,  and 
the  effect  of  rubbing  this  upon  the  affected  parts  would 
probably  be  more  serious  than  the  frost-bite  itself.  It 
was  always  as  well  to  be  certain  that  one  had  no  frost- 
bites before  returning  to  the  warm  hut." 

"  The  effect  of  food  upon  the  circulation  was  very 
well  marked.  After  one  had  been  under  way  pulling  a 
sledge  for  four  or  five  hours,  if  there  was  any  wind, 
one  started  feeling  cold,  and  then  began  to  be  frost- 
bitten. On  camping  and  having  something  hot  to  drink 
the  effect  was  immediate.  One  felt  the  heart  begin  to 
beat  strongly  and  powerfully,  and  gradually  a  glow 
spread  downward  into  one's  feet  and  generally  over 
one's  body.  On  cold  days,  when  the  temperature  was 
below  -40°  F.,  if  the  air  were  still  one  was  not  at  all 
subject  to  frost-bite,  but  immediately  a  slight  or  strong 
breeze  sprang  up  with  a  rise  of  temperature  one's  face 


HYGIENE  OF  HOT  AND  OOLD  CLIMATES    141 

became  affected.  The  amount  of  evaporation  on  a  windy 
day  compared  with  that  of  a  still  day  is  about  the  pro- 
portion of  five  to  one.  After  washing  and  removing  fatty 
substances  from  the  face  one  was  more  susceptible  to 
frost-bite." 

"  Effect  of  Concentrated  Food  after  Man-hauling 
for  more  than  Two  Months.  —  All  parties  noticed  after 
being  out  for  more  than  two  months  man-hauling  that 
they  got  practically  no  satisfaction  from  the  concen- 
trated food.  One  became  exactly  like  a  machine.  With 
a  certain  quality  of  food  it  was  possible  to  go  on  for  a 
certain  time  and  do  a  certain  amount  of  work.  With  a 
little  extra  food  a  little  more  work  could  be  done.  With 
the  ration  that  was  provided,  after  a  time  one  started 
feeding  on  one's  tissues.  Emaciation  was  extreme  on 
the  return  from  the  Southern  journey,  and  the  effects 
of  cold  were  naturally  much  more  severe  in  this  state. 
Owing  to  the  fatty  nature  of  the  food  defecation  was 
extremely  easy,  and  one  reacted  in  this  way  immedi- 
ately to  any  increase  of  food." 

"  The  monotony  of  travelling  over  a  dead  white  sur- 
face on  overcast  days,  when  no  horizon  was  visible,  was 
extremely  marked.  It  can  only  be  likened  to  intellectual 
starvation. 

"  The  effect  of  a  cold  trip  upon  the  constitution  was 
extremely  well  marked,  though  with  nothing  definite. 
In  any  trip  extending  up  to  a  week,  where  the  tempera- 
ture was  continuously  below  -40°  F.,  the  men  returned 
in  an  extremely  low  state.  During  this  time  one  never, 
while  in  the  sleeping  bag,  got  any  conscious  sleep,  and 
once  or  twice  there  were  well  marked  cases  of  men 
sleeping  while  actually  under  way.  This  want  of  sleep 
caused  a  general  lowering  of  the  constitution,  and  the 


142    THE   RECRUIT  AND   HIS  ENVIRONMENT 

lassitude  after  a  cold  sledging  journey  is  a  thing  always 
to  be  remembered." 

"  Snow-hlindness  on  Bright  Days.  —  If  one  did  not 
wear  glasses,  even  for  so  short  a  time  as  half  an  hour, 
on  those  bright  days,  one  was  practically 
'  certain  to  have  an  attack  of  snow-blind- 
ness. The  eye  felt  perfectly  well  while  at 
work  in  the  open,  but  the  initial  symptom  was  always 
noticed  upon  entering  a  tent  where  a  Primus  stove  was 
alight.  The  attack  began  with  a  feeling  of  grains  of 
sand  in  the  eye.  There  was  marked  spasm,  conjunctiv- 
itis, and  weeping.  Photophobia  was  well  marked.  This 
lasted  for  a  varying  period,  the  eye  being  irritable  for 
as  long  as  two  days,  even  with  treatment.  The  conjunc- 
tiva was  congested  and  swollen,  and  the  condition  one 
of  extreme  discomfort.  It  was  a  pure  conjunctivitis  and 
due  entirely  to  the  sti'ength  of  the  illumination.  .  .  . 
When  away  sledging  the  tea  leaves  used  to  be  saved 
after  luncheon  and,  made  into  a  rough  poultice,  were 
worn  over  the  affected  eye  under  the  snow  goggles.  This 
always  produced  a  greater  degree  of  comfort  and  was 
beneficial." 

"  Snow-hlindness  on  Overcast  Days  with  Strong  and 
Diffused  Light. — On  these  days  there  was  want  of 
contrast,  and  the  diffusion  of  light  was  caused  by  re- 
fraction and  reflection  of  light  from  the  surfaces  of 
minute  ice  crystals,  which  were  continuously  falling. 
The  light  therefore  came  from  all  directions  equally. 
It  was  impossible  to  distinguish  the  difference  between 
foreground  and  horizon.  One's  appreciation  of  where- 
abouts was  practically  limited  to  the  skis  on  one's  feet. 
Contrast  was  entirely  absent  because  of  want  of  shadow, 
and,  as  an  instance,  it  was  possible  to  be  standing  within 


HYGIENE  OF  HOT  AND  COLD  CLIMATES    143 

arm's  length  of  a  snow  cairn  9  feet  high,  and  for  the 
cairn  to  be  invisible.  Eye-strain  was  continuous,  the  eye 
striving  to  make  out  whether  the  foot  was  being  placed 
on  an  even  surface.  It  was  impossible  to  appreciate  any 
inequalities,  such  as  sastrugi.  At  the  same  time  the  illu- 
mination was  intense.  The  result  of  these  two  conditions 
was  to  cause  conjunctivitis  plus  diplopia  from  the  tir- 
ing of  the  eye  muscles.  The  diplopia  was  exceedingly 
marked,  and  lasted  for  some  considerable  time.  It  was 
impossible  to  accommodate  for  any  object,  and  it  was 
only  on  going  into  the  tent  or  seeking  any  dark  object 
near  that  the  diplopia  was  realized." 

"  Snow-blindness  on  Dull,  Overcast  Days.  —  On  such 
days  the  effect  was  entirely  one  of  eye-strain.  Although 
the  eyeball  was  congested  to  a  varying  degree,  the  main 
effect  was  due  to  eye-strain,  and  diplopia  was  much 
more  marked.  The  want  of  contrast  was  the  same,  but 
the  intensity  of  illumination  was  absent. 

"  The  deductions  from  the  above  are  that  snow-blind- 
ness is  in  part  eye-strain,  and  in  part  due  to  the  actual 
effect  of  light." 

For  the  prevention  of  snow-blindness,  leather  goggles 
with  amber  glasses  are  recommended.  Care  must  be 
taken  that  no  metal  comes  in  contact  with  the  skin,  that 
the  glass  is  well  away  from  the  eye,  and  that  the  entrance 
of  light  from  the  sides  is  excluded.  Eskimo  "  snow-eyes," 
or  wooden  spectacles  with  slit-like  openings  for  vision, 
are  said  to  be  excellent.  The  use  of  veiling  across  the 
eyes,  and  the  practice  of  marching  with  the  eyes  fixed 
on  the  back  of  the  man  ahead,  the  leader  being  changed 
at  short  intervals,  are  at  times  helpf uL 


PART  II 

THE  CAUSES  OF  DISEASE 

•'  He  discovereth  deep  things  out  of  darknejs,  and  bringeth  otU  to 
light  the  shadow  of  death." 

Job  12 :  22. 


CHAPTER  VIII 

THE  REMOTE   OR  PREDISPOSING  CAUSES   OP  DISEASE 

For  our  purposes  it  may  be  assumed  that  most  of  the 
diseases  with  which  we  are  concerned  are  due  to  animal 
or  vegetable  parasites ;  but  not  every  man  exposed  to 
infection  by  such  parasites  contracts  the  diseases  caused 
by  them.  A  special  predisposition  or  liability  is  neces- 
sary, otherwise  everybody  would  have  tuberculosis,  the 
entire  army  at  Chickamauga  in  1898  would  have  had 
typhoid  fever,  and  all  physicians  would  die  of  infectious 
diseases  within  a  short  time  after  entering  upon  their 
profession.  This  matter  of  liability  or  immunity  to 
diseases  is  one  of  the  most  interesting,  complicated, 
and  important  in  the  whole  realm  of  medicine,  and 
many  of  the  world's  greatest  thinkers  and  investi- 
gators find  it  worthy  of  their  highest  efforts  and  con- 
stant attention.  It  is  the  purpose  of  this  chapter  to  deal 
with  these  questions  in  some  elementary  aspects  that 
should  be  known  by  the  company  officer,  in  a  practical 
and  simple  way,  without  technicalities. 

One  of  the  most  important  of  the  factors  concerned 
in  predisposition  to  disease  is  heredity.    Every   man 
inherits  from  his  ancestry  something  that 
renders  him  liable  to  tuberculosis,  but  im-  ■* 

mune  to  rinderpest  and  chicken-cholera.  He  possesses 
in  a  degree  not  possessed  by  any  other  known  creature 
a  liability  to  malaria,  syphilis,  gonorrhoea,  yellow  fever, 
cholera,  smallpox,  and  other  diseases,  while  he  shares 
with  many  other  animals  his  susceptibility  to  tubercu- 
losis, suppuration,  plague,  and  anthrax,  and  at  the  same 


148  THE  CAUSES  OF  DISEASE 

time  he  is  not  at  all  subject  to  some  diseases  that  are 
very  fatal  to  his  domestic  animals. 

In  addition  to  its  influence  in  this  general  sense,  he- 
redity has  long  been  credited  with  great  influence  in 
predisposing  certain  families  or  individuals  to  certain 
diseases.  Consumption  was  long  looked  upon  as  a  hered- 
itary disease,  but,  with  our  more  complete  knowledge 
as  to  its  nature,  the  tendency  is  now  to  regard  its  ap- 
pearance and  persistence  in  families  as  an  evidence  of 
familial  contagion  rather  than  of  heredity.  In  the  case 
of  cancer,  another  disease  prone  to  "  run  in  families," 
the  same  explanation  is  now  frequently  advanced, 
though  no  germ-cause  is  known  for  the  disease.  The 
influence  of  heredity,  though  still  considered  weighty, 
is  not  now  so  much  emphasized  as  formerly  as  a 
cause  of  insanity.  In  all  these  diseases,  however,  it  is 
still  contended  that  a  predisposition,  a  type  of  tissues 
endowed  with  resisting  powers  below  the  normal,  is  in- 
herited, even  if  the  disease  has  an  extraneous  cause. 
Disease  can  at  times  be  born  with  the  child,  and  not 
manifest  itself  until  later,  the  actual  disease  germ 
being  present  in  the  body  all  the  time.  Syphilis  is 
the  ailment  most  often  showing  this.  Other  diseases, 
such  as  typhoid  and  smallpox,  may  be  contracted  in  the 
uterus,  and  the  child  may  be  born  sick.  It  is  probable 
that  sometimes  disease  may  be  suffered  and  recovered 
from  in  the  mother's  womb,  and  the  attack  confer  im- 
munity through  later  life. 

Certain  persons  appear  to  possess  all  their  lives  an 
immunity  to  certain  diseases,  never  contracting  them  in 
spite  of  frequent  and  direct  exposure.* 

^  Captain  C.  F.  Craig  and  the  •writer  were  quite  unable  to  infect  cer- 
tain indiyiduals,  who  volunteered  for  the  purpose,  with  dengue,  using 
methods  usually  successful  and  injecting  doses  of  infected  blood  many 
times  as  great  as  would  be  received  in  natural  infections. 


PREDISPOSING  CAUSES  OF  DISEASE    149 

Certain  nervous  affections  have  no  known  cause  but 
heredity,  the  disease  appearing  in  the  affected  family 
with  great  regularity.  "Bleeders,"  persons  who  bleed 
excessively  or  fatally  from  very  trifling  injuries,  in  most 
instances  inherit  the  tendency,  and  in  a  curious  way,  as  it 
usually  descends  only  through  females  to  manifest  itself 
in  males.  The  drink  habit  is  often  spoken  of  as  inher- 
ited, but  this  is  probably  not  the  case.  An  unstable 
nervous  system,  which  allows  its  possessor  to  fall  more 
readily  a  victim  to  drink  or  other  excesses,  is  inherited. 
It  is  common  observation  that  types  of  body  are  in- 
herited, that  children  look  and  are  built  like  their 
parents,  and  it  is  but  natural  that  they  should  be  pre- 
disposed to  the  same  diseases,  so  far  as  bodily  conforma- 
tion  exercises  any  influence. 

That  this  does  exercise  an  influence  is  indicated  by 
the  table  quoted  on  page  5,  as  well  as  by  popular 
belief.   The  common  remark  that  such  a 
man  looks  as  though  he  might  have  apo-     _   ^ 
plexy  any  day,  or  such  another  man  will  ^ 

probably  die  of  consumption,  are  based  on  facts  long 
noted  by  physicians  and  the  public.  It  is  partly  for  the 
purpose  of  eliminating  persons  so  predisposed  to  disease 
that  the  government  demands  not  only  that  each  man 
shall  be  in  good  health  at  the  time  of  his  enlistment, 
but  that  he  shall  also  conform  to  certain  standards  not 
having  much  bearing  on  his  present  efficiency. 

Certain  diseases  are  known  generally  as  those  of 
childhood,  as  they  are  so  rarely  seen  in  persons  beyond 
that  age.  Scarlet  fever,  measles,  whooping- 
cough,   and  diphtheria  may   all  occur  at        ° 
other  stages  of  life,  but  it  is  with  ever-decreasing  fre- 
quency that  they  do  so,  and  the  phrase  is,  in  general, 


150  THE  CAUSES  OF  DISEASE 

correct.  On  the  other  hand,  cancer,  apoplexy,  cataract, 
and  several  other  troubles  are  so  nearly  confined  to 
aged  persons  that  they  may  be  called  diseases  of  old 
age.  Certain  infections  are  seen  principally  in  early 
adult  life,  so  that  it  is  the  young  soldier  that  usually 
shows  them  in  the  military  service.  Among  them  we 
may  mention  typhoid,  gonorrhoea,  syphilis.  The  ques- 
tion of  age  is  related  to  that  of  recklessness  and  folly, 
and  it  is  partly  for  this  reason  that  the  young  are  in 
general  more  disposed  than  the  old  to  infectious  dis- 
eases. The  prospects  of  recovery  from  an  illness  are 
also  influenced  by  age.  Pneumonia  and  injuries  are 
much  more  serious  in  an  old  than  in  a  young  man.  On 
the  other  hand,  diabetes  and  epilepsy  are  not  usually 
60  serious  in  elderly  persons  as  in  children. 

Certain  persons  are  born  with  peculiarities  of  person 
that  render  them  particularly  liable  to  certain  diseases, 

_  ,     and  no  adequate  explanation  can  be  offered 

Personal     /.to  n  ^ 

_  for  them,  oome  persona  cannot  eat  nsh, 

others  strawberries,  others  eggs,  without 

becoming  sick.  A  large  number  of  persons 

have  such   a   susceptibility   to   the   effects   of  certain 

pollens  that  they  must  leave  their  homes  when  these 

pollens  are  ripe,  or  suffer  from  hay  fever.  Some  men 

suffer  from  asthma  if  they  go  about  a  stable  or  ride 

behind  a  horse,  others  are  made  sick  or  faint  by  the 

presence  of  a  cat  or  the  odor  of  its  urine.  Of  two  healthy 

men,  one  may  suffer  great  discomfort   after  taking  a 

tenth  of  a  grain  of  iodide  of  potash,  while  the  other 

can  take  three  hundred  times  as  much  and  not  suffer 

at  all.    Many  of  these  peculiarities  are  now  believed 

to  be  examples  of  anaphylaxis,  of  which  mention  will  be 

made  in  the  next  chapter.  It  is  quite  probable  that  re- 


PREDISPOSING  CAUSES  OF  DISEASE     151 

lated  phenomena  influence  the  development  and  course 
of  infectious  diseases. 

Worry,  fear,  and  homesickness  strongly  predispose 
to,  if  they  do  not  actually  cause,  mental  and  nervous 
diseases.    They  also  appear  to  predispose     __         . 
to  infectious  diseases,  possibly  by  lowering 
the  general  resisting  powers  and  influenc- 
ing the  circulation. 

The  aphorisms  of  all  languages  recognize  the  value 
of  training  in  almost  any  occupation  or  pursuit  in  life. 
Military  authorities  recognize  it  by  the  fact     _     .    . 
that  they  require  the  soldier  to  spend  years  ° 

in  training.  It  is  not  less  valuable  in  sanitary  matters 
than  elsewhere.  The  child  or  the  man  who  is  trained  to 
reason,  to  obey,  and  to  conduct  himself  properly,  is  in 
much  less  danger  from  infectious  diseases  in  camp  or 
elsewhere  than  is  the  reckless,  disobedient,  or  head- 
strons:  individual  who  knows  no  law  but  his  own  will 
and  appetite.  It  is  the  latter  who  drinks  bad  water, 
eats  poor  food,  contracts  venereal  disease  at  each  op- 
portunity, urinates  and  defecates  in  forbidden  places, 
avoids  vaccination,  seeks  alcoholic  indulgence,  sleeps 
without  his  mosquito-net,  spits  on  the  floor,  and  is 
otherwise  a  source  of  much  worry  and  mischief.  It  is 
because  of  this  lack  of  training  in  hygiene  that  re- 
cruits are  so  apt  to  become  sick  when  brought  into 
camp,  and,  what  is  worse,  to  scatter  their  sickness  in 
all  directions.  As  training  in  hygiene  increases  among 
officers  and  men  with  increase  of  knowledge,  the  results 
show  in  the  sick  report,  and  it  is  not  probable  that  tlie 
evil  conditions  of  the  camps  of  1898  will  ever  be  re- 
peated in  camps  of  the  regular  army.  Whether  or  not 
they  will  be  repeated  in  large  camps  of  volunteers 


152  THE  CAUSES  OF  DISEASE 

remains  to  be  seen,  but  it  is  improbable,  as  we  know 
how  to  prevent  them  and  hope  to  be  able  to  do  so. 

Lack  of  training  on  the  part  of  troops  is  the  most 
important  predisposing  cause  of  disease  in  armies.  It 
is  the  duty  of  all  officers,  of  whatever  rank  or  branch 
of  the  service,  to  endeavor  to  overcome  this  defect,  for 
which  they  are  mainly  responsible.  The  fact  that  a  man 
is  ignorant  or  headstrong  at  the  time  of  his  enlistment 
does  not  justify  his  being  so  a  year  or  three  years  later. 
Medical  officers  should  be  required  to  give  lectures  or 
other  instruction,  but  the  company  officer  should  see 
that  example  and  wise  precept  are  so  constantly  before 
the  minds  of  his  men  that  hygienic  living  becomes  a 
matter  of  habit. 

Aside  from  habit  in  the  large  sense  just  used,  many 
small  and  unimportant  personal  customs  have  an  influ- 
ence  in  predisposing  to  disease.  Eating  raw 
meat  predisposes  to  infestation  with  tri- 
chinaB  or  with  tapeworms,  carelessness  in  hand-washing 
increases  the  liability  to  many  infections  and  poisonings. 
The  habit  of  going  barefooted  may  be  of  very  great 
importance  in  predisposing  to  plague  and  hookworm 
disease.  Careless  habits  in  the  disposal  of  waste  are 
responsible  for  so  many  sanitary  ills  as  to  make  it  evi- 
dent that  the  main  purpose  of  sanitary  training  is  the 
establishment  of  proper  habits. 

The  influence  of  race  as  a  predisposing  factor  of  dis- 
ease is  closely  related  to  that  of  heredity,  habits,  and 
environment,  but  race  in  itself  exercises 
some  influence.  The  reason  for  this  is  not 
always  known,  but  in  some  instances  it  is  probably  due 
to  long  racial  exposure  to  certain  diseases,  whereby 
only  the  more  resistant  strains  or  families  survive.  At 


PREDISPOSING  CAUSES  OF   DISEASE     153 

other  times  it  is  probably  the  case  that  the  disease  in 
question  may  be  uniformly  incurred  in  childhood,  and 
so  confer  protection  through  later  life.  Whatever  the 
reason,  Cubans  and  West  African  natives  are  less  sus- 
ceptible to  yellow  fever  than  Americans  and  Europeans. 
Jews  are  especially  subject  to  diabetes,  and  negroes  are 
much  more  apt  than  other  peoples  to  suffer  from  keloid, 
a  form  of  tumor. 

Exposure  to  inclemencies  of  weather  predisposes  to 
numerous  diseases.  Tonsillitis,  pneumonia,  rheumatism, 
and  influenza  are  all  germ-diseases,  yet  the     _, 

frequency  with  which  they  are  ascribed  to  ^ 

•  siiiro 

wetting  or  cold  shows  that  these  influences 

are  not  without  effect.  The  germs  causing  pneumonia, 
diphtheria,  spinal  meningitis,  and  tonsillitis  may  be 
present  in  the  mouths  or  noses  of  healthy  people  and 
produce  no  symptoms,  yet  after  exposure  the  person 
may  sicken.  Similarly,  a  person  may  carry  the  organisms 
of  malaria  or  dysentery,  and  only  become  conscious  that 
he  is  ill  after  a  wetting  or  chilling.  There  is  a  growing 
belief  that  nearly  all  tuberculosis  infections  are  received 
in  early  life,  and  that  the  appearance  of  the  disease  only 
at  a  later  period  is  due  to  a  lowering  of  resistance  at 
that  time,  whether  by  an  attack  of  typhoid  or  measles, 
by  hard  work,  poor  food,  exposure,  or  other  cause. 

Injury  predisposes  to  very  many  diseases.    Pneu- 
monia,  meningitis,  and   typhoid,  of  general   diseases, 
may  follow  injuries  in  such  a  manner  as     _   . 
to  appear  related  to  them.   Abscesses,  kid-  ^ 

ney  and  liver  troubles,  and  tumors  may  follow  injuries 
that  do  not  break  the  skin,  while  anthrax,  erysipelas, 
most  suppurations,  "  blood-poisoning,"  hospital  gan- 
grene, lockjaw,  hydrophobia,  and  some  other  affections 


154  THE  CAUSES  OF  DISEASE 

are  preceded  by  breaks  in  the  skin  in  nearly  all  in- 
stances, though  these  may  be  so  small  as  not  to  be 
noticed  at  the  time.  It  is  through  the  wounds  that  the 
disease-producing  organisms  gain  entrance  to  the  body. 
In  the  strict  sense  it  is  also  through  wounds — insect 
bites  —  that  malaria,  yellow  fever,  plague,  and  sleeping 
sickness  are  transmitted.  The  great  class  of  suppura- 
tions, however,  are  the  principal  diseases  following  in- 
jury, and  the  proper  use  of  the  first-aid  packet  for  the 
purpose  of  preventing  them  has  almost  done  away  with 
one  of  the  greatest  horrors  of  war. 

Injury  may  also  act  as  a  means  of  diffusing  and  gen- 
eralizing an  affection  previously  isolated  and  relatively 
harmless.  It  may  rupture  an  abscess  due  to  appendi- 
citis, and  so  give  rise  to  general  and  fatal  peritonitis, 
or  it  may  loosen  the  infected  clot  in  an  inflamed  vein, 
and  cause  acute  general  "  blood-poisoning." 

As  is  shown  in  Part  I  of  this  book,  the  soldier's 
environment  includes  so  much  that  it  must  exercise  an 
.  influence    in  predisposing  hira  to,  or  pro- 

tecting him  against,  nearly  all  sorts  of  dis- 
eases. It  is  so  large  a  matter  that  it  cannot 
be  adequately  mentioned  in  a  paragraph,  and  the  whole 
subject  of  hygiene  touches  on  it.  The  consideration  of 
some  phases  of  it  occupies  the  remainder  of  this  chapter. 

There  are  quite  a  number  of  "  occupation  diseases," 
so  called  because  their  development  depends  on  injury 
_  due  to  the  employment  of  the  individuals. 

4.  ^  Among  such  diseases  may  be  mentioned 
writer's  cramp,  painter's  colic,  chimney- 
sweep's scrotum,  housemaid's  knee,  and  many  others. 
During  and  after  the  Civil  War  a  certain  type  of 
dilated  and  irritable  heart  was  known  as  soldier's  heart, 


PREDISPOSING  CAUSES  OF  DISEASE    155 

and  In  the  stress  of  a  hard  campaign  many  more  cases 
may  develop.  In  the  early  months  of  1899,  when  the 
State  troops  were  doing  much  hard  marching  in  the 
Philippines,  many  such  cases  were  seen.  Occupation 
has  a  great  effect,  however,  in  other  and  less  obvious 
ways.  Thus  it  may  expose  a  soldier  to  mosquito  bites 
and  so  predispose  him  to  malaria,  yellow  fever,  or 
dengue;  it  may  put  him  on  guard  in  a  prison,  where 
he  will  contract  typhus  or  relapsing  fever.  Men  work- 
ing about  stables  are  more  apt  than  others  to  suffer 
from  lockjaw  after  wounds,  as  the  germ  occurs  in 
horse-manure.  Occupations  involving  the  breathing  of 
much  dust,  such  as  marble-cutting,  scissors-grinding, 
and  some  weaving,  predispose  to  tuberculosis.  Seden- 
tary occupations  may  impair  digestion,  allow  muscles 
to  atrophy,  and  cause  hemorrhoids.  Callings  involving 
great  strains  or  exertion  predispose  to  diseases  of  the 
heart  and  blood-vessels.  It  is  stated  that  the  majority 
of  Japanese  jinricksha  men  are  dead  or  invalids  from 
circulatory  diseases  before  they  attain  the  age  of  forty. 
Occupations  causing  much  worry  or  nervous  strain 
predispose  to  nervous  exhaustion.  Overwork  in  almost 
any  calling  may  predispose  to  disease,  either  by  lower- 
ing or  exhausting  the  general  resisting  powers  of  the 
body,  or  by  exhausting  the  nervous  supply. 

The  quality  of  the  air-supply  is  very  important  as 
predisposing  to  disease,  by  its  temperature,  dryness,  or 
purity.  Too  great  heat,  especially  if  moist,  . 
causes  much  discomfort  and  may  result  in 
heat-exhaustion,  heat-stroke,  and  death.  Rooms  that 
are  too  hot  cause  the  men  to  sweat  and  to  expose  them- 
selves unduly  to  cold  or  draughts,  which  may  result  in 
congestions  of  the  lungs  or  kidneys.  Booms  that  are 


156  THE  CAUSES   OF  DISEASE 

too  cold  allow  the  body  to  become  chilled  on  the  sur- 
face and  congested  internally,  making  easy  the  devel- 
opment of  coughs,  sore  throat,  and  other  troubles.  In 
barracks,  however,  such  troubles  are  usually  more  closely 
related  to  foulness  and  contamination  of  the  air  than 
to  its  temperature.  One  case  of  sore  throat  in  a  squad- 
room  may  sufi&ce  to  contaminate  the  air  and  expose 
every  man  in  the  room  to  disease  if  the  ventilation  is 
poor.  This  condition  is  aggravated  with  every  increase 
in  crowding.  Carbon  dioxide  and  other  waste-products 
of  the  body  may  also  make  the  air  poisonous  without 
considering  infection. 

Foggy  or  damp  air  predisposes  somewhat  to  rheu- 
matism. That  which  is  too  dry  causes  dryness  and 
irritation  of  the  respiratory  surfaces.  Dusty  air  intro- 
duces many  infections,  among  them  tuberculosis,  and 
it  is  for  this  reason  that  spitting  on  floors  or  streets  is 
very  dangerous.  The  spit  dries  and  is  pulverized,  and 
eventually  becomes  dust,  in  which  condition  it  may  be 
blown  or  inhaled  into  sound  noses  or  throats,  carrying 
with  it  the  disease-producing  germs.  Dust-laden  air  is 
responsible  for  many  more  "  colds  "  than  is  cold  itself. 

The  use  of  contaminated  water  predisposes,  of  course, 
to  water-borne  infections.    In  addition,  the  use  of  very 

hard  water  or  of  water  containing  chemi- 

cals  may  so  disturb  the  digestive  organs  as 
to  make  infection  easier.  Excessive  water-drinking  dis- 
turbs the  digestion  and  causes  unnecessarily  profuse 
sweating  and  urination ;  deficiency  of  it  causes  irrita- 
tion of  the  kidneys  and  bladder,  constipation,  and 
general  insufficiency  of  waste  elimination.  Greater  in- 
sufficiency of  course  causes  direct  suffering  from  thirst. 

Aside  from  the  very  numerous  infections  conveyed 


PREDISPOSING  CAUSES   OF   DISEASE     157 

by  uncooked  or  improperly  cooked  foods,  the  kind, 
amount,  and  preparation  of  the  articles  used  have  so 
great  an  influence  on  health  as  to  make  the  _ 

subjects  of  catering  and  cookery  worthy  of 
the  company  officer's  best  thought.  He  should  learn 
what  foods  are  good,  their  digestibility,  food-values, 
cost,  and  the  amounts  to  be  furnished.  The  method  of 
preparation  should  be  such  as  to  make  them  attractive 
and  digestible.  The  ration  forms  an  excellent  basis. 

Excess  of  food  predisposes  to  stomach  and  intestinal 
disorders,  to  gout,  obesity,  vascular  and  kidney  diseases, 
and  to  various  forms  of  auto-intoxication,  or  self-poison- 
ing by  waste  products.  Insufficiency  of  proper  food  leads 
to  weakness,  loss  of  flesh  and  a  lessened  resistance,  that 
renders  infections  more  easy.  Great  epidemics  of  typhus 
and  relapsing  fever  have  followed  famine  and  depriva- 
tion so  many  times  as  to  earn  for  them  the  title  of 
famine  fevers,  and  our  present  knowledge  that  they  are 
louse-borne  enables  us  to  appreciate  the  influence  of 
misery  in  lowering  physical  and  moral  tone. 

Alcohol  is  the  direct  cause  of  such  diseases  as  delirium 
tremens,  alcoholic  neuritis,  and  gastric  catarrh ;  but  it  ia 
also  a  predisposing  cause  of  many  other 
diseases,  —  of  the  blood-vessels,  heart,  kid- 
neys, and  brain.  It  also  predisposes  to  infections,  both 
by  making  its  user  careless  in  regard  to  them  and  by 
lowering  the  resisting  powers.  Drunkards  are  especially 
subject  to  pneumonia,  and  are  also  especially  un- 
favorable subjects  for  that  disease.  The  chronic  gastric 
catarrh  of  the  old  alcoholic  may  make  him  an  easy 
victim  for  cholera  or  typhoid.  Alcohol  predisposes 
to  heat-exhaustion  in  hot  and  to  freezing  in  cold 
climates. 


158  THE  CAUSES  OF   DISEASE 

Insufficient  or  excessive  clothing  may  predispose  to 
disease  as  do  heat  and  cold.  Insufficient  covering  in  the 
tropics  may  lead  to  severe  sunburn,  or,  if 
°  of  the  head  or  spine,  predispose  to  heat- 
stroke. Lack  of  foot-covering  not  only  leads  to  injury 
of  the  feet,  but  predisposes  to  diseases  that  usually  enter 
through  the  skin  of  the  feet,  including  hookworm  dis- 
ease, chiggers,  Guinea  worm,  and  plague.  Insufficient 
clothing  may  also  predispose  to  mosquito-borne  diseases. 
Excessive  clothing  may  predispose  to  heat-stroke,  ex- 
haustion, and  diarrhoea,  and  this  is  especially  true  when 
men  are  turned  out  for  inspection  or  drill  in  too  heavy 
uniforms. 

Warm  baths,  if  followed  by  exposure  or  chilling,  may 
predispose  to  disease,  as  may  cold  ones  in  persons  who 
do  not  react  promptly.  Insufficient  bathing 
°  predisposes  to  skin  diseases,  especially  in 
hot  countries ;  bathing  in  polluted  waters,  to  water- 
borne  infections.  In  addition  to  typhoid,  dysentery, 
cholera,  and  common  intestinal  worms,  there  is  reason 
to  believe  that  schistosomum  disease  —  infestation  with 
a  worm  that  lives  in  the  veins  of  the  liver,  and  causes 
bleeding  and  other  serious  bowel  and  bladder  symp- 
toms—  may  occur  during  bathing,  the  young  parasites 
entering  through  the  skin.  This  disease  is  widespread 
in  Africa,  and  varieties  of  it  are  seen  in  the  West  Indies 
and  the  Philippines,  so  that  it  may  yet  assume  impor- 
tance with  us. 

The  use  of  dirty  water  also  predisposes  to  skin  dis- 
eases, as  noted  in  regard  to  the  oft-bathing  Japanese. 
The  exposure  incident  to  bathing  in  streams  may  in- 
crease the  liability  to  diseases  conveyed  by  mosquitoes 
and  other  insects. 


PREDISPOSING  CAUSES  OF  DISEASE     159 

Natural  sleep  in  proper  amounts  is  an  important 
factor  in  the  prevention  of  disease ;  the  lack  of  it  causes 
weakness,  exhaustion,  and  depression  that 
render  infection  and  injury  easy  matters.  ° 

Insufficient  sleep  for  a  long  period  of  time  causes  ner- 
vous disorders  and  predisposes  to  insanity.  Sleeping  in 
improper  surroundings  may  greatly  increase  the  liability 
to  disease  through  chilling,  wetting,  exposure  to  mos- 
quito bites,  and  in  other  ways.  Sleeping  in  close  contact 
with  persons  suffering  from  certain  contagious  diseases 
would  strongly  predispose  to  them,  as  would  sleeping 
in  the  beds  or  clothing  of  such  persons. 

Poor  sanitary  police  is  a  feature  of  poor  military 
training,  and  predisposes  to  all  of  the  epidemic  forms 
of  infectious  diseases.  It  does  this  by  allow- 
ing  infected  dust  and  papers  to  blow  about 
and  pollute  the  air,  by  allowing  soil  and  water  con- 
tamination, by  leaving  or  providing  breeding-places  and 
food  for  flies,  fleas,  mosquitoes,  rats,  and  other  vermin, 
and  by  failure  to  remove  sources  of  infection.  In  these 
ways  it  encourages  the  development  of  typhoid,  cholera, 
dysentery,  yellow  fever,  plague,  pneumonia,  influenza, 
tuberculosis,  and  other  diseases. 

By  attention  to  police  and  general  cleanliness  of  per- 
sons, houses,  and  neighborhoods  some  diseases  that  for- 
merly occurred  in  great  epidemics  have  been  almost  ban- 
ished from  civilized  countries,  and  even  famine  does  not 
bring  them  forth  as  in  earlier  times.  Typhus  and  relaps- 
ing fevers  are  striking  examples.  Tuberculosis  and  other 
diseases  have  been  reduced  in  part  by  similar  measures. 

As  the  best  police  is  possible  only  when  all  unite  in 
striving  for  it,  it  is  essential  that  line  officers  and  en- 
listed men  should  become  interested  in  the  sanitary 


160  THE  CAUSES  OF  DISEASE 

importance  of  the  question,  and  should  look  on  good 
policing  as  a  source  of  pride,  comfort,  safety,  and  effi- 
ciency. 

A  poor  camp-site  may  constitute  a  predisposing  cause 
to  many  kinds  of  disease.  It  may  expose  the  men  to  fog, 
unnecessary  dampness,  wind  and  cold,  or  to 
*^"  dust  and  heat,  to  mosquitoes,  flies,  fleas,  bad 
water,  or  contaminated  soil,  and  through 
these  factors  promote  the  development  of  the  worst 
camp-diseases.  While  it  is  highly  desirable,  therefore, 
to  select  as  good  camp-sites  as  can  be  obtained,  it  must 
ever  be  borne  in  mind  that  proper  sanitary  precautions 
may  nullify  the  evil  effects  of  a  bad  site,  and  that 
neglect  of  them  is  almost  certain  to  destroy  the  value 
of  a  good  one.  Polluted  sites,  those  that  have  been 
much  used  by  troops,  and  those  that  expose  the  men  to 
bad  water  and  disease-bearing  insects  are  particularly 
to  be  avoided,  as  these  factors  predispose  so  strongly 
to  various  diseases  that  only  the  best  trained  and  disci- 
plined troops  may  come  off  unharmed. 

Practically  every  case  of  infectious  disease  is  derived 
from  some  other  one,  and  it  is  therefore  obvious  that 
^  the  existence  of  one  case  constitutes  a  f  ac- 

FfOSGXlCO 

tor  predisposing  to  more.  One  man  with 
typhoid,  cholera,  smallpox,  or  plague,  in  a 
camp,  constitutes  a  danger  to  the  entire  command,  and 
this  fact  is  so  well  recognized  in  these  and  other  dis- 
eases that  it  forms  the  basis  of  the  entire  system  of 
quarantine  and  isolation.  The  origin  of  individual  cases 
of  infectious  diseases  may  be  difficult  to  trace,  the  ty- 
phoid-carrier, the  unsuspected  syphilitic,  or  the  man 
with  a  slight  diphtheria,  not  even  realizing  that  he  is 
sick,  and  unknowingly  spreading  disease  broadcast.  One 


PREDISPOSING  CAUSES  OF  DISEASE     161 

disease  may  predispose  to  the  development  of  another 
or  to  new  manifestations  that  are  spoken  of  as  new 
diseases.  Thus  blood-poisoning,  gonorrhoea,  typhoid, 
and,  more  particularly,  acute  articular  rheumatism, 
predispose  to  valvular  heart-disease,  syphilis  to  cer- 
tain affections  of  the  nervous  system  and  to  aneurysm, 
diphtheria  to  varying  forms  of  paralysis,  and  amoebic 
dysentery  to  abscess  of  the  liver. 


CHAPTER  IX 

THE  IMMEDIATE   OR  EXCITING  CAUSES    OF    DISEASE 

The  immediate  or  exciting  causes  of  some  diseases, 
among  which  may  be  mentioned  such  important  ones  as 
scarlet  fever,  measles,  yellow  fever,  and  typhus,  are  un- 
known, but  those  that  are  known  are  so  numerous  and 
of  such  varied  character  that  they  could  not  possibly 
be  discussed  in  this  chapter,  even  if  it  were  desirable 
that  they  should  be.  We  will  therefore  omit  all  discus- 
sion of  the  causes  of  large  and  important  groups  of 
diseases,  and  consider  only  briefly  the  various  classes 
of  disease-producing  factors  which  it  seems  it  would 
be  interesting  or  profitable  for  the  company  officer  to 
know.  Numerous  as  they  are,  such  factors  may  be 
gathered  into  a  few  groups. 

Of  these  groups,  the  first  to  be  considered  is  that  of 
mechanical  causes,  and,  of  such,  traumatism  or  violence 
is  probably  the  most  important.  Like  the 
other  components  of  this  group,  it  may  pre- 
dispose to  disease,  but  it  is  also  the  direct 
or  exciting  cause  of  many  ills,  among  which  we  may 
class  practically  all  varieties  and  instances  of  wounds, 
from  the  slightest  abrasion  to  the  most  extensive  shell- 
wound,  fractures,  dislocations,  and  bruises.  Concussion, 
laceration,  or  rupture  of  internal  organs,  such  as  the 
brain,  spinal  cord,  liver,  kidneys,  stomach,  intestines, 
or  bladder,  may  result  from  blows  or  other  injuries  that 
cause  no  break  in  the  skin,  or  even,  in  rare  instances, 
leave  no  external  mark.  At  times  the  violence  may  be 


EXCITING  CAUSES  OF  DISEASE         163 

slight  in  degree,  and  apparently  out  of  all  proportion 
to  the  resulting  damage.  Thus,  a  relatively  slight  blow 
on  the  chin  may  be  so  directly  transmitted  to  the  brain, 
and  so  jar  and  shake  it,  as  to  cause  immediate  and 
deep  unconsciousness;  or  a  blow  over  a  distended 
stomach  or  bladder  may  rupture  it  and  cause  death,  to 
the  great  surprise  of  all  witnesses.  Or  the  evil  effects 
of  the  injury  may  not  be  manifested  at  once.  A  knee 
or  hip,  for  instance,  may  be  injured  and  give  rise  to  no 
symptoms  at  the  time,  but  later  cause  prolonged  suffer- 
ing or  lameness  ;  or  a  man  may  receive  a  severe  blow 
on  the  head  or  the  abdomen,  and  continue  at  his  work 
all  day,  yet  he  may  have  received  an  injury  from  which 
he  will  die  in  a  few  days.  Officers  should,  therefore, 
exercise  much  care  and  forbearance  before  they  pro- 
nounce a  man  a  malingerer  because  some  accident  from 
which  he  suffered  appeared  trivial  or  harmless.  Vio- 
lence may  be  so  transmitted  as  to  manifest  its  effects 
on  a  distant  part.  Thus  a  man  may  fall  from  a  height 
and  land  on  his  feet,  and  yet  fracture  his  skull ;  or  he 
may  fall  on  his  hands  and  fracture  his  collar-bone ;  or 
he  may  receive  a  blow  on  the  right  side  of  the  head 
and  suffer  a  laceration  of  the  left  side  of  the  brain.  As 
the  manifestations  of  violence  may  be  almost  infinite 
in  variety,  so  may  its  effects.  Pressure  may  also  cause 
disease  in  a  variety  of  ways.  Applied  to  the  feet  it 
may  cause  deformity,  bunions,  or  corns ;  to  the  waist, 
displacement  of  internal  organs  ;  to  a  nerve,  as  by  a 
bullet  or  a  bone-fragment,  paralysis  or  great  pain; 
applied  to  a  blood-vessel,  it  may  cause  ulceration  and 
rupture,  with  fatal  bleeding,  or  it  may  cut  off  the  blood- 
supply  of  the  part  to  which  the  vessel  runs,  and  cause 
gangrene  or  death. 


164  THE  CAUSES  OF  DISEASE 

Heat  and  cold^  besides  predisposing  to  disease,  aa 
shown  in  the  preceding  chapter,  may  directly  cause 
injuries  varying  from  the  slight  reddening  of  the  mild- 
est burn  or  chilblain  to  the  loss  of  entire  limbs,  or  of 
life  itself.  They,  as  well  as  violence  and  pressure,  in 
addition  to  the  immediate  damage  done,  may  cause  life- 
long suffering  or  deformity,  from  the  formation  or 
contraction  of  large  scars,  or  by  means  of  secondary 
infections. 

Increase  or  diminution  of  atmospheric  pressure  may 
cause  disease  or  death,  the  former  in  divers  or  caisson- 
workers,  the  latter  in  mountain-climbers  or  balloonists. 
In  the  case  of  increased  pressure,  the  trouble  most 
often  comes  from  too  sudden  return  to  normal  pressure, 
which  allows  the  liberation  of  nitrogen  gas  in  the  blood. 

Electricity  may  cause  disorders  varying  from  slight 
pain  or  nervous  disturbance  to  deep  burning  or  sudden 
death. 

Mechanical  injuries  not  usually  thought  of  as  such 
are  exemplified  by  the  rashes  or  irritations  due  to  han- 
dling or  contact  with  some  caterpillars  or  moths,  and  are 
caused  by  the  introduction  and  retention  in  the  skin  of 
the  minute  barbed  hairs  that  partly  cover  the  creatures. 

The  group  of  chemicals  that  cause  disease  or  death 

is  very  large  and  embraces  practically  all  poisons.  They 

,  may  occur  in  any  form,  gaseous,  liquid,  or 

solid,  and  may  enter  the  body  in  any  way, 

as  by  inhalation,  by  mouth,  by  the  rectum,  through  the 

skin,  or  through  wounds. 

Gaseous  poisons  usually  enter  the  system  by  inhala- 
tion. Those  most  commonly  causing  trouble  are  carbon 
dioxide,  water  gas,  coal  or  charcoal  gas,  or  carbon 
monoxide.    These  and  other  gases  may  produce  death 


EXCITING  CAUSES  OF  DISEASE        165 

without  occasioning  great  suffering.  Another  group,  in- 
cluding formalin,  ammonia,  chlorine,  and  sulphurous 
fumes,  cause  marked  irritation  of  the  respiratory  tract 
and  excite  efforts  at  escape,  so  that  they  are,  in  that 
respect,  less  dangerous.  Certain  others,  such  as  some 
compounds  of  arsenic  or  phosphorus,  may  cause  poison- 
ing by  inhalation  in  small  amounts,  and  be  very  diffi- 
cult to  trace.  Chloroform  and  ether  usually,  and  wood- 
alcohol  and  some  other  liquids  occasionally,  enter  the 
body  in  a  vaporous  or  gaseous  form.  Gases  may  produce 
death  in  any  one  of  several  ways :  by  acting  mechan- 
ically to  exclude  oxygen,  and  so  cause  suffocation,  as  in 
the  case  of  nitrogen ;  by  forming  combinations  with  the 
blood  to  prevent  its  taking  up  oxygen,  even  if  it  has 
the  opportunity,  as  in  the  case  of  charcoal  gas ;  by  caus- 
ing paralysis,  or  change  of  nerve-tissue,  as  in  the  case 
of  chloroform  or  wood  alcohol ;  by  causing  such  irri- 
tation of  the  glottis  as  to  close  it  by  swelling,  and  so 
induce  suffocation,  as  does  ammonia. 

Liqvid  poisons  may  also  cause  injury  or  death  in  a 
great  variety  of  ways.  The  group  includes  a  large 
number  of  substances.  Some  of  them,  such  as  sulphuric 
and  nitric  acid^  do  injury  by  their  strong  corrosive 
properties  ;  others,  as  alcohol,  act  on  the  nerves.  They 
usually  enter  the  body  by  way  of  the  mouth,  but,  as  in 
the  case  of  the  acids,  they  may  act  on  the  surface,  or 
enter  through  wounds. 

The  poisons  occurring  in  solid  form  are  even  more 
numerous  than  the  others,  and  they  enter  the  body  in 
the  greatest  diversity  of  ways,  and  produce  manifold 
symptoms.  General  poisons  include  a  great  variety  of 
substances,  such  as  arsenic,  phosphorus,  antimony,  mer- 
cury, lead,  and  a  great  many  more.  They  may  be  taken 


166  THE  CAUSES  OF  DISEASE 

knowingly  with  good  or  evil  intent,  or  in  ways  not 
known  at  the  time,  and  often  difficult  to  trace.  The 
amount  taken  at  one  time  may  be  almost  infinitely 
small,  yet  its  frequent  repetition  may  result  in  poison- 
ing. Thus,  a  painter  may  contract  lead-poisoning  from 
the  minute  amounts  of  lead  getting  on  his  food  from 
unwashed  hands,  a  beer-drinker  from  the  lead  taken 
into  solution  from  lead  pipes  through  which  the  beer  is 
drawn. 

Alkalies,  such  as  caustic  potash,  caustic  soda,  lye, 
and  quicklime  are  powerful  irritants  or  caustics. 

Vegetable  poisons  include  substances  producing  dis- 
ease or  death  in  a  great  variety  of  ways.  Some  of  the 
most  common  and  familiar  of  these  are  opium,  strych- 
nine, cocaine,  and  jimpson  weed.  Most  of  the  enslaving 
drugs  —  alcohol,  opium,  cocaine,  and  others  —  are  of 
vegetable  origin.  Habitual  users  of  them  may  get  to 
using  enormous  doses,  some  of  them  several  times  the 
amount  that  would  be  fatal  to  persons  not  so  habitu- 
ated. Some  vegetable  poisons  are  very  irritating  to  the 
skin  and  cause  marked  eruptions.  Croton  oil  causes 
pustules  that  resemble  those  of  smallpox.  Poison  ivy 
owes  its  evil  qualities  to  an  oil  that  occurs  in  and  on  the 
leaves  and  that  causes  the  well-known  inflammation  of 
the  skin. 

Many  of  the  chemical  poisons  are  the  products  of 
germ  action.  Alcohol,  the  best  known,  results  from  the 
action  of  yeast  cells  on  sugar.  Ptomaines  result  from 
the  action  of  germs  on  meats,  fish,  milk,  and  other  food- 
stuffs. There  are  a  great  many  of  them,  and  their  effects 
vary  greatly.  Some  of  them  resemble  drugs,  such  as 
morphine,  strychnine,  or  atropine,  in  their  action,  and, 
as  their  presence  may  not  be  suspected  at  the  time  they 


EXCITING  CAUSES  OF  DISEASE         167 

are  taken  into  the  system,  the  symptoms  produced  by 
them  may  prove  very  puzzling.  It  should  be  borne  in 
mind  that  ptomaines  may  not  be  destroyed  by  boiling, 
and  cooking  should  therefore  not  be  depended  upon  to 
render  partially  decomposed  meat  safe.  Many  of  them 
are  harmless,  but  neither  can  that  fact  be  depended 
upon  to  show  that  a  given  article  of  food  is  wholesome. 
Their  poisonous  character  depends  on  the  type  of  organ- 
ism producing  them,  rather  than  on  the  stage  of  decom- 
position. Thus  one  piece  of  meat  may  be  quite  rotten, 
and  yet  not  poisonous,  while  another  that  is  free  from 
odor  and  presents  a  fairly  good  appearance  may  be  very 
dangerous. 

The  foods  that  most  often  give  rise  to  ptomaine  poi- 
soning  are  those  that  have  been  preserved  imperfectly, 
such  as  beef  or  fish  in  cans  that  have  become  perfo- 
rated or  blown,  cold-storage  beef  that  is  not  well  frozen 
or  chilled,  poultry  imperfectly  chilled,  especially  if  it  be 
undrawn,  and  imperfectly  cured  hams  and  sausages. 
The  symptoms  vary  considerably,  depending  on  the 
source,  character,  and  amount  of  the  poison  ingested, 
but  in  most  instances  they  include  evidence  of  marked 
gastro-intestinal  and  nervous  disturbances,  such  as  vom- 
iting, diarrhoea,  headache,  dizziness,  and  cramps.  Self- 
poisoning  or  auto-intoxication  may  be  due  to  ptomaines 
or  other  decomposition  products  resulting  from  the 
putrefaction  of  food,  occurring  in  the  stomach  or  bowels, 
or  to  simple  retention  and  absorption  of  poisonous  pro- 
ducts which  would  ordinarily  be  eliminated,  but  which, 
because  of  constipation,  kidney  disease,  or  for  some 
similar  reason,  remain  in  the  body.  Such  poisonings  are 
promoted  by  overeating,  lack  of  exercise,  and  by  ex- 
cessive drinking  or  smoking,  as  well  as  by  diseases. 


168  THE  CAUSES  OF   DISEASE 

Certain  small  organs  of  the  body,  known  as  the  duct- 
less glands  or  glands  of  internal  secretion,  have  a  tre- 
_ .  mendous  influence  on  development  and  wel- 

-  .        fare,  and  their  injury  or  destruction  may 

It  fll  cause  grave  disease.  Among  such  disturb- 
„  ances  are  exophthalmic  goitre,  due  to  excess 

. .  of  secretion  of  the  thyroid  gland,  and  myx- 

oedema  and  cretinism,  the  latter  a  form  of 
idiocy,  due  to  its  absence.  The  most  familiar  instance* 
of  the  influence  of  internal  secretion  are  seen  in  the 
absence  of  the  usual  sex  characters  in  animals  castrated 
or  spayed  wlien  young,  the  absence  of  testicular  or  ova- 
rian internal  secretion  being  responsible.  The  differ- 
ences shown  in  the  development  of  a  stallion  and  that 
of  a  gelding,  of  a  bull  and  a  steer,  a  ram  and  a  wether, 
a  normal  bitch  and  a  spayed  one,  are  obvious  to  all. 

Animal  poisons^  in  addition  to  the  products  of  animal 
waste  to  which  reference  has  just  been  made,  include 
such  substances  as  snake-venoms  and  those  of  stinging 
insects  and  spiders.  These  vary  greatly  in  their  com- 
position, and  their  effects  range  from  the  slight  itching 
and  burning  of  a  mosquito  bite  to  the  agonizing  deaths 
following  some  snake  bites.  The  venoms  are  introduced 
through  wounds,  many  of  them  being  harmless  if  applied 
to  the  unbroken  skin  or  even  if  taken  by  mouth. 

Deprivation  diseases  have  been  discussed  in  the 
chapter  on  foods. 

The  most  important  group   of   the   larger   animal 

parasites   that  infest  man  is  that  of  the 

.°  intestinal    worms.      Their   distribution   is 

.         world-wide,  and  in  some  places  they  are  so 

prevalent  and  their  effects  so  serious,  that 

they  exercise  very  important  influences  on  the  mor- 


EXCITING  CAUSES  OF   DISEASE         169 

bidity  and  mortality  rates.  They  may  be  grouped  in 
three  classes:  the  flukes  or  sucking-worms,  the  tape- 
worms, and  the  roundworms. 

Flukes  or  sucking-worms  are  not  common  parasites 
of  man  in  our  own  country,  but  in  some  parts  of  the 
world  they  are  very  prevalent  and  cause  serious  illness. 
Several  varieties  occur  in  the  Philippine  Islands,  and 
some  of  them  cause  death.  One  variety  occurs  in  the 
lungs,  and  causes  blood-spitting  and  cough  that  may 
lead  to  the  belief  that  tuberculosis  is  present ;  or  it  may 
lodge  in  the  brain  and  cause  paralysis  or  other  cerebral 
symptoms.  Other  varieties  live  in  the  veins  of  the  liver 
and  may  produce  disease  of  that  organ,  while  their  sharp- 
pointed  eggs  lodge  in  or  perforate  blood-vessels  of  the 
bowels  or  bladder  and  cause  bleeding,  irritation,  and 
other  symptoms.  This  is  a  type  of  the  schistosomum 
disease  mentioned  in  the  preceding  chapter.  Although  it 
is  claimed  that  this  particular  class  of  flukes  may  enter 
the  body  through  the  skin,  th©  usual  history  of  the  flukes 
is  that  they  pass  a  part  of  their  lives  in  the  bodies  of 
snails  or  other  small  water-animals,^  and  enter  the  hu- 
man body  only  by  way  of  the  mouth.  Even  though  both 
methods  of  infection  be  possible,  the  obvious  means  of 
prevention  are,  first,  to  prevent  infected  or  egg-bearing 
feces  or  urine  from  reaching  water  ;  second,  to  boil  or 
otherwise  sterilize  the  drinking  water  ;  third,  to  abstain 
from  bathing  in  infected  water  unless  it  also  be  boiled 
or  filtered  ;  fourth,  to  avoid  the  use  of  uncooked  foods 
that  may  have  been  contaminated  by  bad  water. 

The  tapeworms  are  better  and  more  widely  kn^wn 

^  Flukes  in  general,  so  far  as  their  life-history  is  understood,  have  at 
different  times  four  forms  or  stages  and  two  or  three  methods  of  mol- 
tiplication. 


170  THE  CAUSES  OF  DISEASE 

as  human  parasites.  There  are  many  varieties  of  them, 
but  the  best  known  are  those  large  species  ingested 
with  beef  and  pork,  though  others  are  important,  and 
some  of  these,  such  as  the  broad  tapeworm  from  fish, 
may  be  very  important  in  places.  The  life  history  of 
tapeworms,  while  not  so  complicated  as  that  of  flukes, 
involves,  in  most  instances,  residence  in  two  animals, 
and  knowledge  of  it  enables  us  to  understand  the  man- 
ner in  which  infestation  occurs,  and  the  method  of 
avoiding  it.  Life  begins  in  the  eggs,  which  are  passed 
from  the  worm  into  the  bowel-contents  of  its  host,  and 
thence  to  the  outer  world.  Here  they  may  fall  into  water 
or  on  vegetation, or  the  excrement  itself  may  be  ingested 
by  animals.  At  any  rate,  the  eggs  must,  in  one  way  or 
another,  get  admission  to  the  alimentary  canal  of  the 
second  host,  for  which  purpose  a  particular  species  of 
animal  is  necessary.  In  the  case  of  the  beef  tapeworm, 
this  host  is  the  ox,  in  that  of  the  pork  tapeworm,  the 
pig.  Rarely  this  development  may  occur  in  other  ani- 
mals, or  in  man  himself,  but  ordinarily  development  will 
not  occur  in  any  but  the  usual  host.  Having  reached 
the  stomach  of  this  host,  the  embryo  is  set  free  when 
its  enveloping  shell  is  dissolved,  and  penetrates  the  wall 
of  the  stomach,  whence  it  passes  by  the  blood  vessels  to 
the  liver,  muscles,  brain,  or  other  part  of  the  body, 
where,  after  undergoing  some  further  development,  it 
becomes  the  head  and  neck  of  a  future  worm,  inclosed 
in  a  small  bladder,  like  cyst  or  measle,  from  one  fourth 
to  three  foui'ths  of  an  inch  in  length  and  about  one  third 
of  an  inch  in  diameter  in  the  case  of  the  pork  measle, 
and  somewhat  smaller  in  the  case  of  the  beef  measle.  If 
now  the  flesh  of  the  infected  pig  or  ox  be  eaten  raw,  or 
not  cooked  sufficiently  to  kill  the  worm,  it  may  pass  un- 


EXCITING  CAUSES  OF  DISEASE         171 

harmed  to  the  bowel  of  man  and  there  attach  itself  and 
grow.  The  head  and  neck  as  ingested  are  very  small, 
bearing  comparison  in  size  to  a  small  pinhead  and  a 
piece  of  fine  twine.  From  this  head  and  neck  the  rest  of 
the  worm  develops  in  the  bowel.  The  part  so  developing 
consists  of  a  great  number  of  segments,  at  times  hun- 
dreds, each  flat  and  white,  so  joined  together  as  to  form 
a  long  flat  ribbon  that  may  attain  a  length  of  thirty  or 
more  feet,  each  segment  having  a  nervous  and  alimen- 
tary system  and  male  and  female  generative  organs,  and 
each  developing,  fertilizing,  and  discharging  eggs,  so 
that  each  tapeworm,  though  an  individual,  may  be  said 
to  be  also  a  community.  It  may  be  readily  understood 
from  the  above  that  allowing  pigs  to  act  as  scavengers  of 
human  ordure,  as  is  often  the  case  in  the  tropics,  is  not 
a  wise  sanitary  measure.  It  was  stated  above  that  man 
might  rarely  be  the  measly  host.  In  such  cases  he  might 
become  infected  with  eggs  by  means  of  contaminated 
water,  or  of  lettuce  or  other  green  vegetables  manured 
with  human  feces,  by  getting  the  minute  eggs  on  his 
hands  in  water-closets  or  from  his  own  stool,  or  by 
having  them  pass  from  the  bowel  to  the  stomach  during 
vomiting.  Several  other  varieties  of  tapeworms  may 
infect  man,  —  one  of  the  most  dangerous,  and  one  for 
which  man  may  shelter  the  cystic  stage  with  fatal  re- 
sults, being  derived  from  the  dog,  and  another  danger- 
ous one  possibly  being  derived  from  the  rat,  which  may 
deposit  the  eggs  on  food  articles  with  its  feces. 

Many  varieties  of  roundworms  infest  man,  and  their 
life-histories  vary  greatly.  A  few  varieties  will  be  briefly 
discussed  in  order  to  indicate  more  clearly  the  neces- 
sity of  certain  sanitary  precautions.  Those  most  com- 
monly inhabiting  the  human  intestine — thelarge^wJiite 


172  THE  CAUSES   OF  DISEASE 

roundworm^  the  loJilpworm^  and  the  pimoorm  or  seat- 
worm —  require  no  other  host,  and  infection  occurs, 
directly  or  indirectly,  from  man  to  man.  The  egg9  are 
laid  in  the  feces  and  pass  from  the  anus,  whence  they 
may  get  on  the  hands,  into  drinking  water,  or  on  green 
vegetables,  and  so  obtain  entrance  to  the  mouth  and 
stomach  of  the  same  or  another  person.  The  embryos 
are  set  free  in  the  stomach  or  intestine  and  develop 
into  adults.  Probably  the  most  common  method  of  in- 
fection is  by  means  of  polluted  water.  Children  and 
adults  who  are  infested  with  seat- worms  may  reinfect 
themselves  many  times,  by  reason  of  the  fact  that  these 
worms  often  crawl  from  the  anus  and  give  rise  to  most 
intense  itching,  in  the  efforts  to  relieve  which  the 
hands  and  nails  pick  up  many  of  the  microscopic  eggs, 
which  may  later  be  transferred  to  the  nose  or  mouth. 

The  hookworms  are  probably  the  most  important  of 
all  the  worms  infesting  man,  both  because  they  may 
and  do  infect  the  great  majority  of  the  inhabitants  in 
some  tropical  countries,  and  because  they  so  seriously 
reduce  health  and  strength.  In  Porto  Rico,  the  Philip- 
pines, and  our  own  Southern  States,  infestation  with 
these  worms  is  common,  and  thousands  and  thousands 
of  persons  are  debilitated  or  incapacitated,  and  have 
their  resistance  to  other  disease  reduced  by  it,  with 
the  result  that  industrial  progress  is  delayed  and  physi- 
cal degeneracy  and  high  sickness  and  death-rates  pro- 
moted. Formerly  it  was  believed  that  infestation  with 
this  parasite  occurred  in  the  same  manner  as  with  those 
just  described,  but  it  is  now  generally  admitted  that  it 
usually,  if  not  always,  occurs  in  another  way.  The  usual 
history  is  about  as  follows :  The  adult  female  pro- 
duces a  great  number  of  eggs  that  pass  out  from  the 


EXCITING  CAUSES  OF  DISEASE         173 

host  with  his  feces.  If  passed  on  moist,  warm  earth, 
the  eggs  hatch  and  liberate  microscopic  embryonic 
worms  which  eat  feces  or  other  organic  matter,  live 
and  grow  in  the  moist  earth,  and  eventually,  if  fortu- 
nate, find  an  opportunity  to  get  on  the  bare  feet  or 
other  skin-surface  of  a  person,  penetrate  the  hair  fol- 
licles and  tlie  true  skin,  producing  itching  and  irrita- 
tion, and  causing  "ground  itch,"  gain  access  to  the 
lymph  or  blood-vessels,  and  are  carried,  by  way  of  these 
channels,  to  the  lungs.  Here  they  leave  the  blood  and 
pass  out  on  the  mucous  membrane,  crawl  up  the  wind- 
pipe to  the  throat,  from  there  down  to  the  stomach, 
and  then  to  the  small  intestine,  where  they  take  up 
their  abode,  reach  adult  life  and  a  length  of  one  third 
or  one  half  an  inch,  and  in  turn  produce  eggs  to  infect 
more  polluted  soil.  In  addition  to  this,  they  produce 
a  very  serious  anaemia  or  thinning  of  the  blood,  which 
gives  rise  to  weakness,  shortness  of  breath,  dropsy, 
mental  dullness,  and,  in  children,  checked  develop- 
ment and  stunted  physique  and  mentality.  Such  con- 
ditions impair  the  body's  resisting  powers,  and  the  vic- 
tims more  readily  succumb  to  malaria,  dysentery,  and 
other  diseases. 

The  short  outline  of  the  life-history  of  the  worm  just 
given  indicates  the  wisdom  of  the  following  measures 
to  prevent  the  spread  of  the  infestation:  first,  treat- 
ment of  all  infested;  second,  proper  disposal  of  feces 
to  prevent  soil-pollution ;  third,  the  wearing  of  shoes 
in  infected  regions ;  fourth,  the  use  of  pure  drinking 
water. 

Trichiniasis  is  a  disease  produced  by  infestation 
with  a  kind  of  roundworms,  trlchmce,  that  presents 
still  another  life-history  and   method  of  infestation. 


174  THE  CAUSES  OF  DISEASE 

The  trichlnse  are  small  worms  about  a  sixteenth  of  an 
inch  in  length  that  are  natural  parasites  of  the  rat,  but 
may  also  infest  man  and  many  other  animals,  including 
the  pig  and  dog.  The  danger  to  man  lies  principally  in 
the  fact  that  the  pig  is  a  rather  common  host,  and  it  is 
from  that  source  that  he  derives  his  infection.  The 
history  is  as  follows  :  Rats  become  infested  by  eating 
their  infested  kindred,  and  they  in  turn  may  be  eaten 
by  pigs.  The  larval  worms  are  encysted  in  the  muscles, 
as  will  be  described  later,  and  are  set  free  in  the  pig's 
stomach,  when  the  muscle  and  cyst  are  digested.  They 
then  pass  to  the  bowel,  where  they  take  up  their  abode, 
mature,  and  bore  into  or  through  the  intestinal  wall 
to  the  lymph  spaces,  where  they  deposit  their  numer- 
ous progeny,  averaging  about  fifteen  hundred  in  num- 
ber. These  are  carried  along  by  lymph  or  blood-streams, 
or  possibly  by  their  own  activity,  to  various  parts  of 
the  body,  finally  penetrating  the  muscle  fibres  and  set- 
ting up  an  irritation  that  results  in  the  formation  of 
little  capsules  about  them.  Here  they  live  quiescent, 
but  capable  of  development,  for  an  indefinite  time, 
occasionally  for  years.  Too  often,  however,  this  rest 
is  shortened  by  the  death  of  'the  pig  and  its  later  con- 
sumption by  man.  If  such  consumption  is  preceded 
by  thorough  cooking  no  harm  will  result,  as  the  heat 
will  destroy  the  worms ;  but  if,  as  is  sometimes  the 
case,  the  meat  be  eaten  raw  or  underdone,  the  larvae 
are  set  free  in  the  man's  stomach  as  the  others  were  in 
the  pig's,  and  he  in  turn  develops  adults,  has  larvae 
scattered  through  his  muscular  system,  and  suffers  from 
pain,  fever,  symptoms  resembling  typhoid,  and,  possibly, 
death. 

Filaria^  a.  roundworm  whose  larvse  circulate  in  the 


EXCITING  CAUSES   OF  DISEASE  175 

blood,  presents  a  still  different  history  and  method  of 
entrance  to  the  body.  For  at  least  two  varieties,  whose 
development  has  been  pretty  well  traced,  the  history  is 
as  follows :  The  young  or  embryonic  forms  are  imbibed 
with  blood  by  mosquitoes  that  bite  infected  persons.  In 
the  blood  these  embryos,  which  are  about  one  eightieth 
of  an  inch  in  length,  are  inclosed  in  loose  individual 
sheaths  or  capsules,  within  which  they  wriggle  about 
very  actively.  After  reaching  the  mosquito's  stomach 
the  blood  containing  them  clots  and  they  break  through 
their  sheaths,  and,  after  about  a  day,  through  the 
stomach-wall.  They  live  in  the  body  of  the  mosquito, 
growing  and  maturing,  for  two  weeks  or  more,  at  the 
end  of  which  time  they  have  increased  to  four  or  more 
times  their  original  length,  and  have  gathered  in  or 
about  the  fleshy  part  of  the  mosquito's  proboscis.  When 
the  mosquito  next  bites  a  man  they  break  through  a 
thin  part  of  the  proboscis  and  pass  through  his  skin  by 
the  small  wound  from  which  the  mosquito  is  extracting 
blood.  Once  in  the  body,  they  wander  in  ways  and 
parts  unknown  for  an  indefinite  time,  until  they  reach 
maturity,  and,  if  both  sexes  be  represented,  begin  to 
turn  out  embryos  for  other  mosquitoes  to  ingest.  The 
adults  are  very  apt  to  take  up  their  abode  in  lymph- 
vessels,  and  by  their  residence  there  they  set  up  irrita- 
tion that  leads  to  blocking  or  obliteration  of  the  chan- 
nels and  is  thought  to  be  the  cause  of  lymph-scrotum, 
chyluria  (milky  urine),  elephantiasis,  and  kindred 
troubles.  Certain  insect  larvce  that  bear  a  resemblance 
to  roundworms  occasionally  infest  man.  Blow-flies  may 
deposit  their  eggs  on  meat  that  is  left  carelessly  ex- 
posed, and,  if  they  are  not  destroyed  by  heat,  maggots 
may  hatch  from  them  and  appear  in  the  stools  of  per- 


176  THE  CAUSES  OF   DISEASE 

sons  eating  it.  Flies  also  deposit  eggs,  and  maggots 
develop,  on  neglected  sores,  wounds,  or  ulcers,  which 
may  later  be  burrowed  in  many  directions. 

Screw-worms  are  the  maggots  of  a  small  fly  found 
in  some  of  our  Southwestern  States,  in  Central  Amer- 
ica, the  Isthmus  of  Panama,  and  elsewhere.  This 
fly  deposits  its  eggs  in  the  nostrils,  or,  occasionally, 
on  other  parts  of  sleeping  persons,  especially  those 
afflicted  with  nasal  disease  or  very  foul  breath.  The 
maggots  hatch  out  in  a  few  hours  and  bore  their  way 
in  all  directions,  causing  great  suffering  and,  in  many 
cases,  death.  Among  twenty-three  cases  reported  from 
Arizona  in  the  fly  season  of  1905,  there  were  four  deaths. 

Some  flies  deposit  their  eggs  on  or  in  the  skin  of 
animals,  and  the  larva  develop  there,  constituting 
"  warbles  "  in  cattle,  deer,  and  wild  rabbits.  Occasion- 
ally man  is  host,  though  this  is  rarely  so. 

Some  insects  burrow  into  or  beneath  the  skin  in  their 
adult  condition,  and  there  nourish  themselves  and  some- 
times deposit  their  eggs  or  their  young.  They  cause 
irritation  or  disease.  Among  them  may  be  mentioned 
the  itch-mite^  jiggers  or  chiggers^  and  many  kinds  of 
ticks.  Itch  was  at  one  time  a  very  widespread,  com- 
mon, and  intractable  disease,  but  is  no  longer  so. 

Lice  of  various  kinds  are  also  less  common  than 
formerly,  but  are  still  seen  often  enough  as  human 
parasites. 

Leeches  are  at  times  a  great  pest  and  cause  much 
loss  of  blood,  particularly  in  some  parts  of  the  Philip- 
pines, where  they  get  on  troops  marching  through  the 
jungle,  in  great  numbers.  They  may  get  on  the  body 
from  water  or  from  vegetation.  Clothing  is  the  main 
source  of  protection  from  them. 


EXCITING  CAUSES  OF  DISEASE         177 

A  number  of  very  important  and  well-known  diseases 
are  caused  by  animal  parasites  of  such  extremely  small 
size  and  so  low  in  the  scale  of  animal  life    jL/r:-,,,*.^ 
that   they  may,  for  our  purposes,  be  re-    A„;jj,ai 
garded  as  closely  allied  to  the  bacteria.   In   parasites 
fact,  even  scientists  are  not  agreed  as  to 
whether  some   of   them,   for   instance   the  germs   of 
syphilis,  yaws,  and  relapsing  fever,  are  animal  or  vege- 
table. A  brief  consideration  of  some  of  the  small  ani- 
mal  parasites   and   the  diseases   they  cause  may  be 
helpful. 

Malaria  is  the  best  known  and  most  common  of 
such  diseases,  and  the  parasites  causing  it  are  better 
known  than  most  of  the  others  occurring  in  man. 
There  are  at  least  three  varieties  of  malaria,  each  caused 
by  its  peculiar  t3'pe  of  organism,  though  these  types 
have  much  in  common.  They  all  live  in  the  blood  and 
in  its  red  corpuscles,  when  so  small  as  to  be  almost  in- 
visible with  the  microscope,  and  there  grow  to  a  consid- 
erable size,  destroying  the  blood-cell  and  converting  it 
into  a  mere  shell  and  some  pigment  granules.  In  twenty- 
four,  forty-eight,  or  seventy-two  hours,  depending  on 
the  variety  of  organism,  they  segment  or  break  up  into 
a  number  of  small  new  organisms,  the  number  varying 
from  six  or  eight  to  fifteen  or  twenty,  and  also  depend- 
ing on  the  type.  These  young  forms  are  set  free  in  the 
blood-stream  with  the  breaking  up  of  the  shell  of  the 
blood-corpuscle  in  which  they  were  contained,  and  in 
turn  attach  themselves  to  new  red  cells,  to  repeat  the 
performance.  Corresponding  to  the  liberation  of  the 
swarms  of  young  comes  the  "  ague  fit,"  or  the  malarial 
chill,  fever,  and  sweat,  and  it  depends  upon  the  type  of 
organism  whether  this  comes  daily,  once  in  two  days,  or 


178  THE  CAUSES  OF  DISEASE 

once  in  three.  Various  combinations  of  infections  may 
make  the  chills  appear  to  come  very  irregularly,  but 
such  irregularities  are  often  explainable  if  the  case  be 
well  studied.  After  a  time  the  body  develops  powers  of 
resistance  that  enable  it  to  overcome  the  effects  of  the 
organism,  and  spontaneous  recovery  may  occur.  Or  the 
recovery  may  be  apparent  only,  and  the  disease  may 
recur  when  chill,  exposure,  or  other  illness  lowers  vi- 
tality. Malaria  causes  many  deaths,  especially  in  the 
tropics,  in  India  about  one  million  annually ;  but  if 
a  single  infection  is  not  fatal  very  soon,  the  tendency 
is  to  recovery,  as  the  parasites  cannot  maintain  their 
powers  indefinitely  unless  they  renew  their  strength 
(in  some  unknown  way)  by  sexual  reproduction,  and 
that  can  only  occur  in  mosquitoes  of  certain  kinds. 
Minute  differences  can  be  detected  among  the  para- 
sites of  any  kind  of  infection,  and  these  are  now 
known  to  mark  sexual  differentiation.  If  the  right 
kind  of  mosquito  bites  the  infected  individual,  these 
sexual  differences  become  more  marked  in  its  stomach, 
and  sexual  conjugation  there  takes  place.  The  impreg- 
nated female  (this  term  is  not  accurate,  but  it  conveys 
the  idea)  bores  into  the  stomach-wall  and  undergoes  a 
development  which  eventually  results  in  the  production 
of  hundreds  or  thousands  of  young  forms  that  finally 
find  their  way  to  the  salivary  glands  and  mouth  of  the 
mosquito,  and  enter,  by  way  of  the  wound  made  by  the 
insect,  the  next  man  it  bites,  and  the  cycle  begins 
again  in  him.  All  malarial  infections  are  conveyed  in 
this  way,  and  where  there  are  not  the  right  kinds  of  mos- 
quitoes the  disease  cannot  originate.  So  far  as  known, 
man  is  the  only  animal,  and  mosquitoes  of  the  sub- 
family anophalincB  the  only  insects,  that  respectively 


EXCITING   CAUSES   OF  DISEASE         179 

harbor  and  transmit  malaria,  and  each  derives  its  in- 
fection from  the  other.  Each  should  therefore  be  kept 
away  from  the  other. 

Amoebic  dysentery,  so  well  known  to  our  army  because 
of  the  great  amount  of  invalidism  it  has  produced 
among  our  soldiers  on  tropical  service,  is  also  due  to 
an  animal  parasite  of  microscopic  size.  This  is  a  minute 
round  mass  of  living  substance  endowed  with  the  ca- 
pacity for  motion,  by  virtue  of  which  it  inserts  itself 
between  the  body-cells  or  wraps  itself  about  them  and 
digests  them ;  destroying  tissue  and  giving  off  poison, 
it  causes  the  formation  of  ulcers  in  the  bowel,  inflam- 
mation of  the  intestinal  siu'face,  bleeding,  wasting,  diar- 
rhoea, and,  too  often,  death.  Entering  the  blood  or 
lymph-streams  through  the  ulcers  they  make  in  the 
bowel,  the  amcehas  may  reach  the  liver  and  there  set  up 
the  dreaded  disease  known  as  liver  abscess.  The  amoebas 
enter  the  body  in  polluted  water,  and  probably  also  on 
lettuce,  radishes,  and  other  vegetables  that  are  eaten 
uncooked. 

Sleejying  sickness,  a  disease  unknown  in  our  posses- 
sions but  caused  by  a  parasite  closely  related  to  that 
causing  the  well-known  and  fatal  surra  of  horses  in 
the  Philippines,  is  widespread  in  central  Africa,  and 
has  caused  tremendous  loss  of  life  there.  The  ororanism 
and  disease  are  transmitted  by  the  bites  of  tsetse  flies. 

Syphilis,  known  everywhere,  is  caused  by  an  ex- 
tremely fine  organism  of  spiral  figure.  This  is  about 
1-2000  of  an  inch  in  length,  and  the  thread  that  is 
twisted  into  the  spiral  shape,  the  organism  itself,  is 
about  1-100,000  of  an  inch  thick.  This  extreme  fine- 
ness, and  the  difficulty  with  which  the  germ  stains, 
account  for  the  fact  that  it  remained  so  long  undiscov- 


180  THE  CAUSES  OF  DISEASE 

ered.  This  organism,  which  is  called  a  Treponema^  is 
not  known  to  occur  elsewhere  than  in  syphilitic  sub- 
jects, but  it  occurs  abundantly  in  lesions  of  the  disease 
and  is  free  on  the  surface  of  such  moist  sores  as  the 
open  chancre  and  patches  in  the  mouth.  If  from  these 
it  passes  to  wounds,  cracks,  or  other  open  and  moist 
surfaces  on  a  healthy  person,  as  may  occur  in  kissing, 
sexual  congress,  or  other  contact,  the  disease  is  trans- 
mitted. 

Yaws,  a  skin  disease  that  occurs  in  the  tropics,  is 
caused  by  an  organism  indistinguishable  in  appearance 
from  that  of  syphilis. 

Many  other  diseases  are  produced  by^animal  para- 
sites, but  it  is  unnecessary  to  consider  them  here. 

Certain  diseases,  such  as  yellow  fever  and  dengue^ 
are  produced  by  unknown  organisms  that  pass  through 
fine  filters  and  are  probably  so  small  as  to  be  invisible 
to  our  microscopes ;  yet  the  course  and  history  of  the 
diseases  point  to  an  animal  rather  than  a  vegetable 
cause. 

The  disease-producing  vegetable  parasites  are  of 
three  classes,  wowZcZs,  yeasts,siud  Saci^eWa,  all  microscopic 
in  size  and  all  of  them  germs.  The  moulds 
_.   °  and   veasts    are    of  minor  consequence  as 

compared  with  the  bacteria,  and  cause  rela- 
tively few  diseases,  and  those  principally  of  the  skin. 
Fatal  general  infections  by  germs  from  both  of  these 
classes  have,  however,  been  reported.  Persons  who  have 
served  in  the  tropics  recall  how  difficult  it  is  there  to 
keep  shoes,  clothing,  trunks,  and  many  other  articles 
from  moulding  or  mildewing,  especially  during  the 
rainy  season.  Heat  and  moisture  afford  such  excellent 
conditions  for  growth  that  a  pair  of  shoes  will  turn 


EXCITING   CAUSES  OF  DISEASE  181 

green  in  a  very  short  time.  As  related  vegetable  forms 
are  responsible  for  many  of  the  most  common  skin- 
diseases  of  the  tropics,  the  fact  helps  us  to  understand 
the  prevalence  of  the  latter.  Not  all  moulds  are  harm- 
ful, and  most  of  them  are  mere  surface  growths.  The 
mistake  is  occasionally  made  of  rejecting  a  quite  good 
ham,  for  instance,  because  it  is  mouldy  on  the  outside. 
Such  mould  can  be  trimmed  off  with  the  rind,  and  does 
not  injure  the  meat.  Roquefort  and  some  other  cheeses 
are  dependent  on  moulds  for  their  flavor,  and  are  not 
good  if  these  be  absent. 

Bacteria^  however,  are  the  best  known  of  the  causes 
of  disease,  so  well  known  as  such,  in  fact,  that  two 
erroneous  ideas  have  arisen  in  consequence : 
one,  that  all  bacteria  produce  disease,  the 
other  that  all  disease-producing  germs  or  micro-organ- 
isms are  bacteria,  or,  to  touch  a  still  greater  error, 
bacilli.  Bacteria  are  microscopic,  one-celled  organisms 
of  vegetable  nature  that  multiply  by  simple  fission.  So 
far  are  they  from  being  universally  harmful,  that  life 
would  soon  disappear  from  the  face  of  the  earth  if  all 
bacteria  were  killed.  This  is  because  of  the  fundamen- 
tal difference  that  exists  between  bacteria  and  the 
larger  forms  of  vegetation.  All  animal  life  is  main- 
tained directly  or  indirectly  by  vegetable  life,  even  the 
lion  and  tiger  being  dependent  on  the  herbivorous  deer 
and  similar  animals.  Most  vegetable  life  draws  its  sub- 
stance from  the  elements  and  simple  compounds  of  the 
earth,  air,  and  water.  In  other  words,  grass  or  a  tree 
cannot  eat  dead  grass,  meat,  or  other  highly  organized 
substances,  until  they  are  first  decomposed  and  broken 
up  into  the  elements  and  simple  compounds  indicated, 
and  returned  in  those  forms  to  the  earth,  air,  or  w^ter. 


182  THE  CAUSES  OF  DISEASE 

For  this  purpose  bacteria  are  necessary,  and  without 
their  action  the  earth  would  soon  be  covered  with  dead 
animals  and  vegetables,  the  fertility  of  the  soil  would 
be  exhausted,  and  life  would  be  choked  out  by  the  ac- 
cumulation of  its  products.  Because  of  this  difference 
and  the  fact  that  bacteria  do  not  contain  cellulose,  as 
do  ordinary  plants,  it  has  been  proposed  to  class  them 
as  a  separate  kingdom  and  regard  them  as  neither  ani- 
mal nor  vegetable.^ 

Bacteria  are  found  practically  everywhere  in  nature, 
and  many  trades  and  industries  are  dependent  on  their 
presence.  They  are  classified  according  to  shape,  group- 
ing, action,  and  other  qualities.  Thus  some  are  called 
putrefactive,  others  nitrifying,  and  others  pathogenic  or 
disease-producing.  The  more  common  forms  are  desig- 
nated as  cocci,  or  little  balls,  bacilli^  or  little  rods,  and 
spirilli  or  vibrios,  or  little  spirals  or  pieces  of  spirals. 
Cocci  in  pairs  are  called  diplococci ;  bound  together  in 
chains,  streptococci  ;  gathered  into  bunches  like  grapes, 
staphylococci  ;  and,  as  each  organism  tends  to  grow  al- 
ways in  the  same  way,  such  names  become  permanently 
attached  as  more  or  less  generic.  Thus  we  speak  of  the 
streptococcus  of  erysipelas,  the  diplococcus  of  pneu- 
monia, and  the  yellow  staphylococcus  of  suppuration. 

Bacteria  may  also  be  cerobic  or  anaerobic ;  the  for- 
mer unable  to  grow  without  oxygen,  the  latter  with  it. 
Tetanus  or  locljaw  is  caused  by  an  anaerobic  bacillus, 
and  that  probably  partly  accounts  for  the  fact  that  it  is 

^  "  It  has  been  generally  assttmed  that  bacteria  are  low  fonns  of 
plant  life,  but  researches  .  .  .  show  that  bacteria  contain  no  cellulose 
and  are  particulate,  unshielded  proteins  and  consequently  are  more 
nearly  related  to  low  forms  of  animal  life.  I  should  not  classify  bact©' 
ria  as  either  plants  or  animals."  —  V.  C.  Vaughan. 


EXCITING  CAUSES   OF   DISEASE  183 

most  apt  to  follow  small  deep  wounds,  such   as  nail- 
punctures,  to  which  the  air  does  not  have  free  access. 

Reproduction  among  bacteria  is  by  fission  or  simple 
division.  One  bacillus  divides  crosswise  into  two,  the 
two  into  four,  and  so  on ;  and  so  rapidly  does  the  proc- 
ess advance,  that  under  favorable  circumstances  the 
increase  amounts  to  uncountable  millions  or  billions 
in  a  day.  The  rapidly  multiplying  individuals  may  be 
bound  together  in  gelatinous  masses  that  are  of  con- 
siderable size,  at  times  forming  a  skin-like  layer  many 
yards  in  extent.  When  conditions  are  less  favorable,  as 
when  all  the  food-supply  is  exhausted,  the  temperature 
too  high,  or  harmful  chemical  substances  present,  the 
bacteria  usually  die  ;  but  some  varieties  may  preserve 
themselves  under  such  circumstances  by  the  formation 
of  spores.  These  may  be  compared  to  the  seeds  of 
larger  plants  in  that  they  are  much  more  resistant  to 
heat,  cold,  and  other  harmful  influences,  and,  after  sur- 
viving such  trials,  may  again  give  rise  to  growth.  An- 
thrax bacilli,  for  instance,  are  readily  destroyed  by 
heat,  but  their  spores  will  withstand  boiling  for  some 
time.  In  preparing  media  for  the  cultivation  of  bacteria 
it  is  therefore  the  practice  to  sterilize  them  at  a  temper- 
ature higher  than  that  of  boiling  water,  or  to  use  that 
temperature  on  three  successive  days.  In  the  latter 
event  the  bacteria  develop  from  the  spores  after  the 
first  sterilization  and  are  killed  in  their  less  resistant 
forms.  The  amount  of  heat  required  to  destroy  bacteria, 
what  is  called  the  thermal  death-point,  varies  greatly 
with  the  species.  Some  organisms  found  in  water,  none 
of  which,  fortunately,  produce  disease,  flourish  in  a  high 
temperature.  All  disease-producing  organisms,  except 
those  in  spore  form,  are  promptly  destroyed  by  boiling, 


184  THE  CAUSES  OF  DISEASE 

and  many  of  them  by  a  lower  temperature.  Few  ordi- 
nary organisms  will  survive  a  temperature  of  67°  C. 
for  more  than  a  short  time,  and  this  fact  gives  the  pro- 
cess of  pasteurization^  as  applied  to  milk,  its  value. 
,  This  is  the  process  whereby  milk  is  heated  to  a  point 
between  66°  and  70°  C.  and  maintained  at  that  tem- 
perature for  ten  or  fifteen  minutes.  This  kills  the  dis- 
ease-producing organisms,  without  changing  the  taste 
and  character  of  the  fluid  as  does  boiling.  For  the 
same  reason,  satisfactory  results  have  been  obtained  in 
the  British  service  with  a  camp  water-heater  that 
raises  the  supply  to  85°  C.  for  only  a  very  short  time. 

Moisture  is  necessary  for  the  growth  of  bacteria,  and 
drying  checks  their  growth  even  when  it  does  not  kill 
them,  as  it  does  many  varieties.  Being  solid  bodies 
heavier  than  air,  bacteria  are  not  given  off  from  moist 
surfaces.  Occasionally  they  may  be  thrown  into  the  air 
with  droplets  of  water  by  the  bursting  of  bubbles,  but 
in  general  a  tubfuU  of  bacteria-laden  water  would  not 
endanger  the  purity  of  the  atmosphere.  On  the  other 
hand,  dried  or  partially  dried  bacteria  may  be  blown 
about  as  dust  and  do  much  harm.  Cuspidors  and  water- 
closets  should  therefore  always  contain  water.  Sunlight 
is  a  great  enemy  to  most  pathogenic  bacteria,  some  of 
them,  for  example  the  cholera  germ,  being  killed  by  a 
very  brief  exposure  to  it,  and  all  being  injured  by  it. 
Many  chemicals,  such  as  bichloride  of  mercury  and 
carbolic  acid,  kill  bacteria  when  brought  into  contact 
with  them.  Such  mistakes  are  often  made  as  that  of 
regarding  a  stool  disinfected  because  some  antiseptic 
solution  has  been  poured  over  it.  As  a  matter  of  fact, 
the  antiseptic  in  such  a  case  is  only  brought  in  contact 
with  the  surface  of  the  fecal  mass  and  the  great  bulk 
of  it  is  quite  as  dangerous  as  before. 


EXCITING  CAUSES  OF  DISEASE         185 

One  variety  of  bacteria  may  tend  to  destroy  another. 
Thus  typhoid  bacilli  will  keep  alive  much  longer  in 
sterilized  than  in  contaminated  water,  the  common 
water-organisms  in  the  last  case  crowding  them  out ; 
and  fecal  matter  arid  its  contained  bacteria  are  very 
quickly  made  to  disappear  if  mixed  with  dry  earth 
containing  an  abundance  of  nitrifying  bacteria,  while, 
if  mixed  with  ashes,  which  are  sterile  because  burned, 
they  persist  much  longer.  This  warfare  of  bacteria 
has  had  exploitation  because  of  the  interest  attach- 
ing to  the  recommendation  that  certain  milk-souring 
bacteria  be  ingested  for  the  purpose  of  crowding  out 
from  the  intestines  more  harmful  varieties,  and  so  less- 
ening the  danger  of  poisoning  by  the  products  of  these. 
This  explains  the  occasional  excellent  effects  of  the  use 
of  buttermilk  as  a  diet. 

On  the  other  hand,  one  variety  of  bacteria  may  in- 
crease the  danger  or  power  of  another  variety.  Thus 
the  tetanus  bacillus,  being  anaerobic,  cannot  grow  in 
the  presence  of  oxygen  ;  but  if  introduced  into  the  body 
with  a  variety  of  organism  that  uses  a  great  deal  of 
oxygen,  the  latter  may  soon  bring  about  practically 
anaerobic  conditions  in  which  the  former  can  flourish. 

The  virulence  of  the  streptococcus  of  erysipelas  is 
greatly  increased  if  the  organism  be  grown  with  bacillus 
prodigiosuSy  an  organism  that  is  itself  not  pathogenic. 
Smallpox,  though  more  than  a  simple  suppuration,  is 
always  associated  with  that  process  and  with  the  com- 
mon pus-producing  bacteria. 

Some  bacteria  produce  disease  by  means  of  the  poi- 
sons or  toxins  that  they  set  free,  rather  than  by  their 
physical  presence  in  the  tissues.  The  bacilli  causing 
diphtheria  and  those  causing  tetanus,  to  cite  examples. 


186  THE  CAUSES  OF  DISEASE 

produce  soluble  toxins  which  can  be  obtained  in  germ- 
free  solutions  and  which,  when  injected,  produce  the 
symptoms  of  the  diseases,  even  though  none  of  the  ac- 
tual germs  are  introduced. 

Other  bacteria,  such  as  those  of  plague,  typhoid, 
cholera,  and  tuberculosis,  do  not  produce  soluble  toxin, 
unless  it  be  that  one  is  set  free  when  the  bodies  of  the 
bacteria  are  digested  or  disintegrated.  Such  bacteria 
are  at  times  spoken  of  as  forming  endotoxins.  The 
exact  manner  in  which  they  cause  disease  is  not  thor- 
oughly understood,  though  recent  investigations  indi- 
cate that  there  are  two  main  factors  involved:  (1)  The 
bacteria,  in  their  efforts  to  nourish  themselves,  digest 
and  so  destroy  certain  body  cells.  (2)  The  body  cells, 
in  their  efforts  to  defend  themselves  from  injury,  destroy 
the  bacteria  by  digesting  or  breaking  them  down,  and 
by  so  doing  liberate  from  them  certain  products  that 
act  as  chemical  poisons.  The  greater  and  more  rapid 
the  defensive  digestion,  so  is  greater  and  more  rapid 
the  liberation  of  the  harmful  products,  and  the  more 
acute  and  violent  are  the  symptoms  of  disease  until,  by 
practice,  the  cells  learn  to  digest  also  the  freed  poison- 
ous products,  when  recovery  may  occur  and  immunity 
be  established.  In  other  words,  the  manifestations  of 
disease  may  be  quite  as  much  evidences  of  the  body's 
resistance  to  infection  as  of  the  existence  of  infection. 
Similar  digestion  by  the  body  cells,  rather  than  by 
the  alimentary  tract,  of  protein  other  than  that  con- 
tained  in  bacteria,  such  proteins,  for  exam- 
v,  i"  •  P^^'  ^^  ^o&"  '^^  serum-albumen,  is  thought 
^  ^  to  account  for  "  serum  sickness  "  and  other 

manifestations  of  anaphylaxis. 


CHAPTER  X 

DISEASE-CARRIERS 

It  has  been  stated  in  preceding  chapters  that  diseases 
are  oftentimes  diffused  by  persons,  animals,  insects,  or 
inanimate  substances  that  act  as  carriers  of  the  infect- 
ive matter  or  germs.  It  will  greatly  aid  in  the  main- 
tenance of  the  health  of  troops  if  company  officers  and 
the  men  themselves  have  a  proper  realization  of  such 
methods  of  spreading  disease,  and  the  better  known 
and  more  important  groups  of  carriers  will  therefore 
be  considered. 

Man  himself  is  the  most  important  carrier  of  his  own 
diseases,  and  most  epidemics  arise  from  the  presence  of 
one  case  of  disease  in  man.  Isolation  and  rr  ,t,q„ 
quarantine  are  designed  to  limit  or  prevent  p-rrpra 
disease-transmission  in  this  way,  and  in  the 
case  of  measles,  scarlet  fever,  smallpox,  and  similar 
diseases  the  danger  is  recognized  by  all.  It  is  not  so 
generally  recognized  in  many  other  common  and  serious 
diseases,  such  as  typhoid  and  "colds."  It  is  not  the 
purpose,  however,  to  discuss  here  the  danger  arising 
from  contact  with  well-marked  cases  of  disease,  but 
rather  to  consider  the  unknown  or  unrecognized  carrier. 
Several  diseases  may  be  widely  disseminated  by  persons 
entirely  ignorant  of  the  fact  that  they  are  sources  of 
danger.  This  fact  has  long  been  recognized  in  regard  to 
some  infections,  is  just  receiving  recognition  in  regard 
to  some  others,  and  is  possibly  not  recognized  at  all  in 
regard  to  still  others.   For  several  years  it  has  been  a 


188  THE  CAUSES  OF  DISEASE 

matter  of  scientific  demonstration  that  active  and  viru- 
lent diphtheria  bacilli  may  linger  for  weeks  or  months, 
in  the  mouths,  throats,  or  noses  of  persons  who  have  re- 
covered from  the  disease  and  who  appear  quite  healthy. 
It  has  also  been  demonstrated  beyond  dispute  that  some 
mild  sore  throats,  "  colds,"  and  nasal  discharges  are  due 
to  diphtheria  germs,  even  though  the  subjects  do  not 
feel  particularly  sick  and  the  diseased  parts  do  not  pre- 
sent the  appearance  formerly  considered  characteristic 
of  diphtheria.  Other  persons  who  have  no  sore  throat 
or  other  evidence  of  disease,  but  who  have  been  in  con- 
tact with  cases,  as  nurses  or  otherwise,  may  harbor  the 
germs.  Persons  in  any  of  these  classes  may  ignorantly 
and  innocently  introduce  the  disease  in  new  localities, 
transmit  the  germs  to  susceptible  people,  and  so  start 
epidemics.  One  such  person  in  a  crowded  and  ill-venti- 
lated squad-room  in  winter  may  endanger  the  whole 
command,  and  if,  in  addition  he  is  a  person  addicted 
to  careless  spitting,  to  the  use  of  other  men's  pipes, 
cups,  or  linen,  the  danger  is  greatly  increased.  The  wise 
and  necessary  precaution  in  military  life  is  to  examine 
and  reexamine  all  men  who  have  had  or  been  exposed 
to  diphtlieria,  and  to  keep  them  isolated  until  it  has 
been  repeatedly  demonstrated  that  they  are  free  from 
germs,  and  to  isolate  cases  of  sore  throat  as  though  they 
were  all  diphtheric. 

The  germs  of  cerebrospinal  meningitis  and  infantile 
paralysis  are  also  occasionally  found  in  healthy  mouths 
and  noses,  and  the  diseases  may  be  transmitted  by  such 
healthy  carriers.  Scarlet  fever  often  leaves  an  irritated 
throat,  a  nasal  discharge,  or  a  running  ear,  and  persons 
who  have  otherwise  recovered  from  it  may  transmit  the 
infection  to  others  and  so  start  epidemics. 


DISEASE-CARRIERS  189 

Typhoid  carriers  constitute  one  of  the  means  of  ty- 
pTioid  transmission  that  is  now  best  recognized  and  is 
always  considered  in  the  investigation  of  an  outbreak 
of  the  disease.  A  chronic  typhoid  carrier  is  usually  a 
person  who  has  had  the  disease  and  apparently  recov- 
ered, but  who  continues  to  excrete  typhoid  bacilli  in  his 
feces  or  urine.  Occasionally,  however,  a  carrier  is  found 
who  gives  no  history  of  the  disease.  Then,  too,  persons 
in  the  early  stages  of  the  disease  may  act  as  carriers 
and  cause  wide  dissemination  of  the  infection  before 
they  give  up  to  their  sickness. 

The  germs  of  cholera  and  dysentery  may  be  passed 
by  persons  quite  ignorant  that  they  harbor  them,  and 
may  give  rise  to  infection  through  contact,  water,  the 
use  of  latrines  from  which  flies  may  obtain  the  germs, 
and  in  other  ways.  Epidemics  of  bacillary  dysentery  or 
"  flux  "  not  rarely  result  from  carelessness  on  the  part 
of  a  carrier  or  a  man  but  slightly  sick.  During  a  jail 
epidemic  of  cholera  which  was  started  by  a  carrier  at 
Puri  jail,  in  India,  in  1912,  thirty  convalescents  were 
examined  at  the  time  of  their  discharge  from  hospital 
and  eleven  of  them  found  to  be  still  excreting  cholera 
germs.  In  August,  1911,  six  cases  of  cholera  were  ad- 
mitted to  the  quarantine  hospital  at  Ellis  Island,  fifteen 
cases  developed  in  quarantkie,  and  thirty-one  carriers 
were  detected. 

As  stated  in  the  preceding  chapter,  man  is  the  carrier 
of  the  commonest  intestinal  worms,  and  it  is  his  ig- 
norance or  carelessness  that  is  responsible  for  their 
spread.  Persons  who  spread  tuberculosis,  tonsillitis,  and 
other  troubles  by  their  careless  spitting  usually  do  it  in 
ignorance  of  the  fact  that  they  are  doing  wrong.  Most 
consumptives  do  not  realize  that  they  have  the  disease 


190  THE  CAUSES  OF   DISEASE 

until  after  they  have  been  expectorating  tubercle  bacilli 
for  some  time.  Other  disease-carriers  who  may  be  quite 
ignorant  of  the  role  they  are  playing  are  sufferers  from 
certain  eye  and  skin  diseases,  such  as  trachoma  or  granu- 
lar lids,  gonorrhoeal  inflammation  of  the  eyes^rlngworm^ 
itch,  impetigo,  and  many  other  diseases  of  the  skin. 
They  may  either  be  ignorant  that  they  have  any  disease, 
or  that  the  diseases  they  have  are  contagious,  and  so,  by 
careless  contact,  the  use  of  public  towels  or  brushes, 
or  those  belonging  to  other  persons,  through  barbers' 
chairs  and  in  other  ways,  they  may  infect  many  persons. 
Nurses  and  doctors  may  at  times  carry  and  trans- 
mit infectious  diseases,  such  as  measles,  smallpox  or 
typhoid,  either  innocently,  as  when  a  diagnosis  cannot 
yet  be  made  and  they  do  not  know  of  the  dangerous 
contact,  or  culpably,  as  when  they  know  of  the  danger 
but  do  not  take  proper  precautions  to  guard  against  it. 
Venereal  diseases,  both  gonorrhoea  and  syphilis,  may 
be  innocently  transmitted,  quite  aside  from  any  ques- 
tion of  sexual  intercourse.  A  syphilitic  infant  may  in- 
fect its  nurse  ;  a  girl  may  get  a  chancre  of  the  lip  from 
kissing  a  person  who  has  infective  lesions  in  the  mouth 
and  does  not  know  it ;  or  possibly,  though  it  must  happen 
very  rarely,  by  following  a  syphilitic  in  the  use  of  a  com- 
munion cup  or  other  public  drinking-vessel;  doctors  oc- 
casionally become  infei^ted  with  syphilis  through  needle- 
pricks  or  slight  scratches  that  become  infected  during 
operations.  A  child  may  contract  gonorrhoea  from  sleep- 
ing with  or  against  its  infected  mother,  or  an  infant's 
eyes  may  be  infected  daring  its  birth,  and  others  may 
become  infected  through  handling  it.  Many  men  who 
thought  themselves  quite  free  from  all  venereal  disease 
have  infected  their  innocent  wives  through  sexual  in- 


DISEASE-CARRIERS  191 

tercourse,  and  every  man  who  has  ever  had  venereal 
disease  should  seek  the  examination  and  opinion  of  a 
competent  physician  before  entering  the  married  state. 

The  company  officer  cannot  be  expected  to  recognize 
the  various  disease-carriers  in  his  company,  but  he  can 
aid  in  their  detection  if  he  sees  that  all  sick  men  report 
promptly  to  the  surgeon,  and  that  they  remain  on  sick 
report  until  no  longer  sources  of  danger.  Occasionally 
a  company  officer  takes  the  unreasonable  view  that  a 
man  who  is  able  to  do  a  bit  of  window-washing  or  other 
light  work  about  the  hospital  should  be  sent  to  his  com- 
pany. Such  action  might  result  most  seriously  both  to 
the  company  and  the  man,  and  the  wise  company  com- 
mander will  very  rarely,  if  ever,  clamor  for  a  sick  man. 
Even  diseases  not  directly  transmissible,  such  as  malaria, 
constitute  a  menace  in  barracks,  and  the  victims  are, 
ordinarily,  not  only  better  off,  but  also  less  dangerous 
when  in  hospital.  A  man  infested  with  worms  may  be 
capable  of  working  and  may  desire  to  do  duty,  but  he 
cannot  be  so  well  treated  elsewhere  as  in  hospital,  nor 
will  the  disposal  of  his  stools  be  so  well  looked  after 
if  he  be  free  to  go  and  to  defecate  where  he  pleases. 

Certain  diseases  are  derived  exclusively  or  almost  so 
from  animals.  Among  them  are  many  very  dangerous 
infections,  some  of  them  quite  incurable.     Animal 
We  will  consider  some  of  these.  Carriers 

Hydrophobia  is  a  disease  that  affects  a 
great  many  kinds  of  animals  and  is  almost  uniformly 
fatal.  It  is  ordinarily  considered  a  disease  of  the  dog 
family,  but  there  is  some  reason  to  believe  that  it  is 
naturally  a  disease  of  certain  herbivora,  especially  rab- 
bits, and  the  dog  contracts  it  from  these.  So  far  as  man 
is  concerned,  however,  it  may  be  considered  as  origi- 


192  THE  CAUSES  OF   DISEASE 

Dating  with  the  biting  animals,  especially  the  dog^ 
wolf ^  fox,  cat,  and  skunk.  By  these  it  may  be  trans- 
mitted to  horses,  cattle,  and  other  domestic  animals, 
and  to  man  himself.  No  cure  is  known  for  the  disease 
after  it  has  actually  begun,  but  if  treatment  be  begun 
soon  after  infection,  immunity  may  be  established  be- 
fore the  incubation  period  has  ended,  and  the  onset 
thus  prevented.  As  there  are  three  prevalent  errors 
regarding  this  disease,  each  fraught  with  the  possibility 
of  serious  consequences,  they  will  be  briefly  discussed 
here. 

The  first  of  them  is  the  somewhat  widespread  belief 
that  the  disease  does  not  exist,  that  its  victims  really 
die  from  fright.  This  is  abundantly  disproved  by 
the  deaths  of  people  who  were  not  fi-ightened,  who  for 
weeks  or  months  had  forgotten  the  incident  of  the  bite ; 
by  the  ability  to  infect  and  kill  rabbits,  dogs,  and  other 
animals,  by  inoculation  from  animals  dead  of  rabies 
but  not  from  those  dying  of  other  diseases  ;  by  the  in- 
fection and  death  of  cattle,  horses,  and  men  ;  by  the 
bites  of  rabid  animals,  but  of  no  others  ;  and  in  other 
ways.  Hydrophobia  exists. 

The  second  error  relates  to  the  diagnosis  of  the  dis- 
ease in  the  dog.  Not  every  dog  that  slobbers  and  bites 
is  rabid,  and  it  is  foolish  and  frequently  a  cause  of  great 
and  needless  worry  to  assume  that  he  is  and  kill  him. 
The  disease  usually  begins  in  the  dog  with  a  change 
of  disposition,  shown  commonly  by  restlessness  and  ir- 
ritability. The  animal  is  easily  startled  and  crouches  in 
fear,  or  it  may  wander  away  from  home.  The  appetite 
may  fail,  or  there  may  be  difficulty  in  swallowing  food. 
Drinking  is  apparently  less  interfered  with,  and  the 
name  hydrophobia  (fear  of  water)  is  not  accurately 


DISEASE-CARRIERS  193 

descriptive.  Even  later,  when,  because  of  paralysis  of 
the  throat,  the  animal  is  wholly  unable  to  swallow,  it 
may  still  lap  water  with  avidity,  though  it  succeeds  in 
doing  no  more  than  wetting  its  mouth.  Change  in  the 
bark  or  absence  of  barking  is  often  noted.  The  dog  may 
show  no  tendency  to  violence,  but  pass  from  a  state  of 
bewilderment  to  aimless  restlessness,  characterized  by 
a  tendency  to  wander  or  to  chew  and  swallow  all  sorts 
of  unusual  articles  such  as  wood,  cloth,  grass,  or  earth,  to 
paralysis  and  death.  Or  it  may  snap  at  things  about  it 
or  at  the  phantoms  of  its  disordered  brain,  and  pass  into 
a  furious  stage,  that  of  typical  madness,  when  it  bites 
or  tears  at  any  thing  or  any  animal  in  its  way.  Always 
the  disease  ends  in  paralysis,  usually  first  showing  in 
the  muscles  concerned  in  swallowing,  later  of  the  hind- 
quarters, the  jaw,  and  the  entire  body,  death  coming 
in  from  four  to  seven  days  after  the  onset.  The  disease 
probably  begins  with  the  invasion  of  the  dog's  brain  by 
the  parasites,  and  the  saliva  is  not  always  dangerous 
at  the  beginning.  The  diagnosis  can  be  properly  made 
only  by  observation  of  the  whole  course  of  the  disease, 
or  by  examination  of  the  animal's  brain.  Therefore,  the 
correct  course  of  procedure  is  either  to  capture  the  dog 
and  confine  it  so  that  the  disease  may  be  observed,  or 
to  hill  it  and  at  once  cut  off  its  head  and  send  that  to 
a  competent  pathologist  for  examination. 

The  third  error  relates  to  treatment  of  bitten  per- 
sons. It  is  computed  that  about  one  sixth  of  the  persons 
bitten  by  rabid  animals  develop  hydrophobia,  the  rest 
escaping  because  the  saliva  was  not  at  the  time  infec- 
tious, because  the  clothing  wiped  all  saliva  from  the 
biting  teeth,  and  for  other  reasons.  Nevertheless,  the 
sixth  that  do  develop  the  disease  always  die,  and  proper 


194  THE  CAUSES  OF  DISEASE 

preventive  treatment  is  essential.  This  consists  in  the 
cleansing  of  the  wound  with  heat  or  antiseptics,  the  pro- 
motion of  bleeding,  proper  dressing,  and  the  Pasteur 
treatment  for  the  establishment  of  immunity.  "  Mad- 
stones  "  and  charms  are  quite  useless. 

Glanders  is  well  known  as  a  disease  of  horses  and 
mules^  less  so  as  a  cause  of  human  illness.  Neverthe- 
less, human  beings  do  contract  it,  usually  with  fatal 
results.  Its  contagious  and  fatal  characters  are  so  well 
recognized  in  the  army,  that  its  presence  constitutes 
proper  grounds  for  the  destruction  of  animals,  even 
though  their  usefulness  is  not  yet  greatly  impaired.  The 
persons  who  most  often  contract  it  are  those  concerned 
in  the  care  and  treatment  of  horses.  As  the  disease  in 
its  early  stages  may  not  present  characteristic  or  well- 
marked  symptoms,  it  may  be  mistaken  for  a  "  cold," 
quinsy,  or  other  less  dangerous  malady,  and  the  animal 
be  handled  or  treated  without  the  observation  of  proper 
precautions  to  prevent  infection.  Special  care  should 
always  be  exercised  to  prevent  any  discharge  from  the 
nose  or  from  sores  on  horses  coming  in  contact  with 
wounds,  scratches,  or  the  respiratory  tract,  and  to  keep 
the  animal  from  blowing  its  nasal  discharge  or  saliva 
into  the  face  of  one  examining  it.  All  suspected  ani- 
mals should  be  isolated  and  handled  as  though  known  to 
be  glandered  until  the  diagnosis  is  settled.  The  disease 
may  also  be  contracted  from  handling  dead  animals 
during  their  removal,  or  in  the  course  of  post-mortem 
examination,  and  proper  precautions  as  to  cleanliness, 
avoidance  of  wounds,  and  disinfection  should  be  ob- 
served. Glanders  and  farcy  are  different  forms  of  the 
same  disease,  are  due  to  the  same  organism,  and  must 
be  treated  with  equal  respect. 


DISEASE-CARRIERS  195 

Plague  or  the  pest  is  one  of  the  most  serious  and  im- 
portant diseases  for  which  man  owes  a  debt  of  hatred 
and  warfare  to  his  animal  neighbors.  It  has  not  as  yet 
gained  an  extensive  footing  in  our  country,  but  it  took 
San  Francisco  some  years  to  get  rid  of  it ;  at  this  writ- 
ing New  Orleans  is  struggling  to  do  so,  while  the  Pan- 
ama Canal  is  menaced  from  Colombia,  Peru,  Chili, 
Cuba,  and  other  points;  and  it  is  only  by  unremitting 
care  that  we  can  hope  to  prevent  its  spread  there  and 
at  home.  Starting  in  southern  China  some  twenty  years 
ago,  it  has  since  invaded  each  of  the  continents  and 
many  of  the  islands  of  the  seas,  while  its  toll  has  been 
millions  of  lives  and  vast  treasure.  As  lately  as  1911  it 
caused  842,000  deaths  in  India,  and  273,000  in  1912, 
199,000  in  1913,  and  178,000  in  the  first  six  months 
of  1914,  in  spite  of  the  active  campaign  that  has  been 
waged  against  it  there  for  almost  two  decades. 

The  investigations  of  the  British  commission  ap- 
pointed to  study  the  disease  in  India  show  clearly  that 
epidemics  of  human  plague  arise  after  and  in  conse- 
quence of  epizootics  of  rat  plague. 'The  infection  is 
transmitted  from  rats  to  man  by  fleas,  usually  those 
of  the  rat,  and  the  relation  of  the  epidemics  to  the 
epizootic  is  beautifully  shown  as  follows :  There  are 
two  principal  species  of  rat  concerned  there,  the  brown 
or  Norway  rat  and  the  black  or  house  rat,  the  former 
also  known  as  the  ship  and  the  sewer  rat.  It  is  among 
that  class  that  the  epizootic  arises,  usually,  and  in  about 
7.2  days  later  it  is  also  prevailing  among  the  house 
rats.  This  7.2  days  is  accounted  for  by  tlie  fact  that 
it  is  also  the  average  experimental  time  elapsing  be- 
tween the  biting  of  the  black  rat  by  an  infected  flea 
and  the  death  of  the  animal.  (The  rise  of  the  epizootic 


196  THE  CAUSES  OF  DISEASE 

is  measured  by  the  numbers  of  rats  found  dead  or  dy- 
ing.) The  black  rat  epizootic  precedes  the  height  of  the 
human  epidemic  by  from  ten  to  fourteen  days,  a  period 
accounted  for  as  follows :  The  rat  flea  does  not  readily 
attack  man  until  starved  for  three  days.  The  incubation 
period  of  human  plague  is  about  three  days.  The  dura- 
tion of  the  fatal  human  plague  averages  four  and  a  half 
days.    Average  total,  eleven  and  a  half  days. 

The  relationship  between  rats  and  human  plague  is 
also  proved  in  other  ways,  but  they  cannot  be  discussed 
here.  The  fact  is  established,  and  it  constitutes  the 
most  important  of  the  many  reasons  why  man  should  be 
at  enmity  with,  and  try  to  exterminate,  rats. 

It  must  be  borne  in  mind,  however,  that  other  ani- 
mals may  be  infected,  and  wild  squirrels  have  been 
shown  to  have  the  disease  in  California.  They  and 
gophers,  prairie  dogs,  and  similar  animals  may  yet 
play  an  important  part  in  disseminating  it.  While  dirt 
and  unsanitary  conditions  cannot  give  rise  to  plague, 
their  influence  in  promoting  the  presence  and  increase 
of  both  fleas  and  rats  is  so  well  recognized  that  it  is 
well  to  mention  the  matter  as  showing  how  they  may 
strongly  predispose  to  disease  that  they  cannot  cause 
directly. 

The  great  Manchurian  epidemic  of  pneumonic  plague 
in  1910  has  been  thought  to  have  originated  among 
trappers  of  plague  -  infected  rodents,  but,  however 
started,  that  epidemic  was  not  spread  in  the  ordinary 
manner.  It  spread  with  tremendous  rapidity  and  killed 
nearly  all  whom  it  infected.  Transmission  was  by  drop- 
let infection  and  inhalation,  the  germs  entered  by  the 
respiratory  tract  and  caused  pneumonia,  and  in  the  few 
months  of  its  raging  the  disease  caused  thousands  of 


DISEASE-CARRIERS  197 

deaths.  However,  the  conditions  favoring  a  similar 
spread  exist  in  few  places.  During  the  summer  myriads 
of  Chinese  go  north  to  work  in  Manchuria.  In  winter 
they  return,  and  the  writer  has  seen  train-loads  of  them 
riding  all  day  in  open  coal  cars,  in  windy  weather  when 
the  temperature  was  below  zero,  and  at  night  stopping 
at  such  places  as  Mukden  and  being  packed  into  close 
and  dirty  inns  as  they  were  packed  in  the  cars  in  day- 
time. It  requires  no  vivid  imagining  to  understand 
how  pneumonic  plague  would  spread  like  wild-fire  when 
introduced  among  men  so  environed.  So  we  see  that 
even  diseases  that  are  ordinarily  insect-borne  may  at 
times  find  man  himself  their  most  favored  carrier. 

Tuberculosis  is  the  most  prevalent  disease  affecting 
man,  and  is  responsible  for  more  deaths  than  any  other 
one  cause.  It  is  also  a  common  disease  of  cattle  and  of 
some  other  animals,  and  it  may  be  transmitted  to  man 
from  them.  Tuberculous  meat,  if  not  sufficiently  cooked 
to  sterilize  it,  may  be  the  medium  of  infection,  but  milk 
is  probably  even  more  commonly  the  carrying  agent.  A 
cow  that  has  tuberculous  disease  of  the  udder  may  give 
off  immense  numbers  of  bacilli,  and  these  may  be  in- 
gested in  a  virulent  condition  in  milk,  cream,  butter,  or 
cheese.  This  method  of  infection  is  so  common  that  some 
authorities  who  have  devoted  great  study  to  the  subject 
contend  that  it  is  the  usual,  if  not  the  exclusive  method, 
and  they  relegate  infection  by  inhalation  to  a  place 
of  very  minor  importance.  Such  a  view  is  extreme  and 
probably  not  correct,  as  shown,  for  instance,  by  the  fact 
that  tuberculosis  is  very  prevalent  in  Japan  and  other 
far  eastern  countries  where  neither  milk  nor  beef  is 
a  common  article  of  food.  Nevertheless,  infection  by 
means  of  these  food-articles  can  and  does  occur,  and  the 


198  THE  CAUSES  OF  DISEASE 

precautions  against  the  sale  of  tuberculous  meat  and 
milk  are  wise  and  salutary.  Observations  made  in  New 
York  and  elsewhere  on  the  type  of  bacilli  found  in 
series  of  cases  of  tuberculosis  of  children  indicate  that 
about  seven  per  cent  of  the  cases  were  caused  by  bacilli 
of  the  "  bovine  type."  Wild  or  range  cattle  are  much 
less  subject  to  the  disease  than  high-bred,  stabled  cattle, 
and  many  other  animals  that  suffer  from  it  in  captivity 
are  free  from  it  in  their  native  wild  state,  thus  showing 
the  predisposing  influence  of  confinement  and  crowding. 

Tuberculosis  is  rather  common  also  in  pigs,  dogs,  and 
cats,  less  so  in  sheep  and  goats.  The  disease  may  be 
transmitted  by  the  flesh  of  pigs.  Pet  animals,  such  as 
dogs  and  cats,  are  apt  to  contract  and  spread  the  infec- 
tion because  of  their  habits  of  licking  up  sputum  and 
other  discharges  to  which  they  may  have  access.  This 
furnishes  another  argument  for  the  proper  care  and 
destruction  of  all  tuberculous  discharges.  The  urine  and 
fecal  discharges  of  men  or  animals  that  have  tubercu- 
losis may  contain  the  bacilli  and  may  constitute  serious 
dangers.  Thus  a  cow  that  is  passing  the  germs  in  these 
ways  may  indirectly  infect  sound  cattle  or  their  milk  by 
means  of  bacilli  blown  about  the  stable  with  the  dust 
of  dried  feces  or  urine,  or  by  soiling  the  pasturage. 

Fish  and  birds  also  have  tuberculosis,  but  it  is  doubt- 
ful if  the  forms  of  it  that  they  have  can  be  transferred 
to  man.  It  is  not,  however,  necessary  to  go  to  the  ex- 
treme lengths  that  fear  may  carry  one  in  the  efforts  to 
avoid  tuberculosis.  Patients  with  the  disease  need  to  be 
taught  to  take  proper  precautions  as  to  the  disposal  of 
their  spit  and  other  excreta,  but  when  they  take  such 
precautions  they  need  not  be  avoided.  In  fact,  among 
investigators  of  tuberculosis  there  is  a  growing  and 


DISEASE-CARRIERS  199 

pretty  widely  accepted  belief  that  practically  all  per- 
sons become  infected  with  the  disease  early  in  life,  and 
that  the  large  majority  overcome  it.  Its  appearance  in 
later  life  is  then  credited  to  a  lowering  of  general  bodily 
resistance,  rather  than  to  a  recent  infection.  This  ac- 
counts for  the  "  predisposing  "  influence  of  typhoid  and 
measles,  they  lower  the  resistance  to  an  infection  that 
already  exists.  Tuberculous  milk  is  best  avoided,  but  if 
the  milk  is  not  known  to  be  infected,  but  is  merely  of 
unknown  or  doubtful  origin,  it  can  be  rendered  safe  by 
boiling  or  pasteurization.  The  indiscriminate  sale  of 
tuberculous  meat  is  properly  forbidden  by  law ;  but  if 
an  animal  is  not  badly  diseased  and  the  visibly  injured 
portions  of  the  carcass  are  rejected,  the  rest  can  be  eaten 
with  safety  if  it  is  first  properly  cooked.  Such  meat 
is  not  purchased  for  the  army,  however,  and  the  above 
statement  is  made  for  its  general  worth  and  not  to  en- 
courage the  acceptance  of  inferior  stores. 

Anthrax  is  a  disease  that  causes  a  very  great  number 
of  deaths  in  cattle  and  sheep  in  various  parts  of  the 
world.  Other  animals  are  also  susceptible  to  it  in  vary- 
ing degrees,  among  them  being  horses,  deer,  pigs,  mice, 
and  rabbits.  Man  suffers  from  it  in  two  or  three  forms, 
generally  obtaining  his  infection  from  the  hides  of  ani- 
mals dying  of  it.  Wool-sorters  and  hide-handlers  are 
therefore  particularly  subject  to  it,  and  one  common 
name  of  the  trouble  is  "  wool-sorters'  disease."  Soldiers 
have  also  been  known  to  be  infected  (though  not  in  our 
army)  through  the  use  of  sheepskin-lined  coats,  or  boots 
made  of  poorly  cured  leather.  The  disease  is  often  fatal, 
and  materials  from  animals  dead  of  it  should  not  be 
used.  It  is  caused  by  one  of  the  spore-forming  bacilli, 
and  the   spores  are  very  resistant  to  both  heat  and 


200  THE  CAUSES  OF  DISEASE 

chemicals.  Human  infection  takes  place  in  two  ways : 
through  cuts  or  abrasions  brought  into  contact  with  in- 
fected skins,  carcasses,  or  other  matters,  and  by  inhala- 
tion of  hairs,  bits  of  wool,  or  dust  that  carry  the  spores. 

It  has  been  definitely  shown  that  several  species  of 
African  antelope  are  capable  of  infection  with  the  tryp- 
anosomes  of  human  sleeping  sickness,  that  tsetse  flies 
may  become  infected  by  feeding  on  them  and  may  trans- 
mit the  disease,  and  that  the  antelope  in  question  are  at 
least  "  potential  reservoirs  "  of  the  disease  and  probably 
actual  ones.  There  is  still  warm  discussion  as  to  whether 
the  government  should  enter  upon  a  policy  of  game 
extermination,  the  opposition  being  based  upon  what 
is  considered  insufficiency  of  proof  of  the  actual  impor- 
tance of  such  reservoirs. 

Man  is  the  occasional  subject  of  some  other  diseases 
of  animals,  and  it  is  a  good  general  rule  to  take  as  much 
care  to  prevent  infection  from  a  sick  animal  as  from  a 
sick  person,  unless  the  disease  is  known  to  be  one,  such 
as  rinderpest,  to  which  persons  are  not  liable. 

Domestic  animals  are  also  occasional  carriers  of  com- 
mon human  diseases.  Dogs  and  cats  have  been  known 
to  have  diphtheria.  Cats  have  been  experimentally  in- 
fected with  whooping-cough,  and  there  is  reason  to 
suspect  that  either  of  these  animals  might  carry  the 
contagium  of  such  diseases  as  smallpox,  scarlet  fever, 
or  measles  in  its  hair.  The  liability  of  getting  ring- 
worms and  other  skin  diseases,  as  well  as  lice  and  fleas, 
from  domestic  animals  has  already  been  mentioned. 

Insects  of  different  kinds  transmit  diseases  in  various 
ways.  The  first  and  simplest  way  is  by  acting  as  simple 
carriers.  Thus  germs  become  attached  to  the  legs  and 
bodies  of  flies  alighting  on  an  infected  wound  or  a  yaws 


DISEASE-CARRIERS  201 

papule,  and  these  by  later  alighting  on  clean  wounds 
or  abrasions  may  leave  the  germs  there  and  _ 
cause  infection.  Or  the  transfer  may  be  -« 
less  direct,  as  in  the  case  of  the  fly  that 
goes  from  a  typhoid  stool  to  a  food-article  and  there 
leaves  germs  to  be  later  ingested  with  the  food.  In 
other  instances  the  simple  deposit  of  the  germs  may 
not  insure  infection,  but  the  irritation  caused  by  the 
insects  may  further  it.  This  is  well  shown  in  the  case 
of  plague.  The  flea  transmitting  that  disease  may  do  so 
by  reason  of  the  fact  that  the  germs  are  adhering  to  its 
mouth-parts  and  are  introduced  directly  by  the  biting 
act  or,  as  has  recently  been  shown,  the  germs  imbibed  at 
a  previous  feed  may  have  so  multiplied  in  the  flea's 
stomach  as  to  obstruct  the  opening  into  it,  with  the  re- 
sult that  when  the  insect  attempts  to  feed  again  the 
pumping  motions  that  it  makes  simply  draw  the  blood 
into  the  oesophagus,  whence,  laden  with  plague  bacilli, 
it  flows  back  into  the  wound.  On  the  other  hand,  the 
mouth  and  external  parts  of  the  flea  may  be  free  from 
germs,  in  which  case  infection  may  occur  as  follows : 
The  flea  has  a  habit  of  defecating  while  it  sucks  blood, 
probably  to  make  room  for  a  larger  meal,  and  in  so 
doing  it  may  deposit  plague-germs  on  the  skin,  near  but 
not  in  the  wound.  If,  now,  the  bite  is  rubbed  or  scratched, 
as  is  often  the  case,  the  germs  may  in  that  way  get  into 
the  wound  and  infection  be  assured.  An  insect  trans- 
mitting the  disease  in  this  last  described  manner  is 
called  a  contaminative  carrier,  and  there  are  some 
diseases,  as  relapsing  fever  carried  by  body  lice,  in 
which  that  and  the  rubbing  in  of  the  contents  of  crushed 
lice,  seem  to  be  the  only  methods  of  infection,  the  bite 
alone  being  harmless. 


202  THE  CAUSES  OF  DISEASE 

More  complicated  processes  are  involved  in  other  in- 
stances, as  in  malaria,  yellow  fever,  or  filariasis,  in  which 
the  parasites  must  undergo  a  cycle  of  development  in  the 
insect ;  and  the  latter  cannot  transmit  the  disease  until 
a  sufficient  time  has  elapsed  to  allow  that  to  occur.  Some 
insects  can  transmit  germs,  and  the  capacity  to  convey 
infection  to  man  or  other  animals,  to  their  offspring. 
This  fact  has  long  been  known  regarding  the  tick  that 
transmits  Texas  fever  to  cattle,  and  it  has  more  recently 
been  proven  true  as  to  those  infecting  man  with  the 
spotted  or  tick  fever  of  Montana  and  the  relapsing  or 
tick  fever  of  Africa.  These  diseases  may  be  transmitted 
by  the  bites  of  ticks  raised  from  the  eggs  of  those  biting 
infected  persons,  but  which  have  not  themselves  ever 
bitten  people  or  had  any  other  chance  than  through 
heredity  to  obtain  the  infection.  The  body  louse  can 
transmit  the  cause  and  power  to  infect  with  European 
relapsing  fever  to  its  offspring,  and  the  same  sort  of 
thing  maybe  true  as  to  some  other  insects  and  diseases. 
Among  proved  or  probable  insect-carriers  of  general 
diseases  are  Jliis  of  various  kinds,  several  species  of 
mosquitoes^  sand-flies  of  some  varieties,  the  harhiero 
of  Brazil, ^eas,  lice,  bedbugs,  ticks,  mites,  and  roaches.^ 

Among  inanimate  carriers  of  disease,  food,  water, 
and  milk  have  already  been  men'ion'id  several  times. 

^  A  most  cnriona  and  interesting  example  of  an  insect  actings  as  a 
carrier  for  another  insect  has  recently  been  worked  out  partially  in 
Central  and  South  America.  A  large  fly,  Dermatobia  cyaniventris,  the 
size  of  the  ordinary  bluebottle  fly,  manages  in  some  manner  as  yet  un- 
known to  get  its  eggs  stuck  to  the  side  of  the  thorax  of  a  variety  of  mos- 
quito, Janthinosoma  ItUzi.  When  the  eggs  hatch  the  larvae  enter  the  skin 
of  a  man  through  the  wound  made  by  the  bite  of  the  mosquito,  and 
there  develop,  causing  abscesses  or  boils. 


DISEASE-CARRIERS  203 

They  may  serve  as  the  conveying  media  for  practically 
all  infections  that  can  occur  through  the  - 
alimentary  canal,  including  such  important  _, 
ones  as  tuberculosis,  typhoid,  cholera,  dys- 
entery, diphtheria,  scarlet  fever,  and  many  others. 
These  articles,  and  milk  especially,  offer  such  opportu- 
nities for  the  multiplication  of  bacteria  that  they  may 
convey  to  the  consumer  many  thousand  times  as  many 
germs  as  originally  had  entrance  to  them.  Thus  a  can 
of  milk,  becoming  infected  with  a  few  hundred  typhoid 
bacilli  from  the  hands  of  a  farmer-carrier,  may,  when 
consumed  in  a  city,  ten  or  twelve  hours  later,  have 
billions  of  germs  in  it,  and  cause  a  great  many  cases 
of  the  disease.  It  is,  therefore,  important  to  prevent 
the  access  of  even  one  disease-germ  to  such  articles, 
and  carelessness  in  their  handling  should  not  be  con- 
doned. Fortunately,  thorough  cooking  will  destroy  dis- 
ease-germs in  all  of  these  substances. 

Clothing,  books,  carpets,  toys,  and  other  personal  and 
household  belongings  that  have  been  handled  or  used 
by  persons  ill  with  such  diseases  as  smallpox,  measles, 
scarlet  fever,  and  diphtheria  may  serve  to  convey  infec- 
tion for  varying  periods  of  time,  periods  fortunately  not 
usually  very  long,  and  for  that  reason  the  disinfection 
or  destruction  of  such  articles  is  resorted  to  as  a  means 
of  preventing  the  spread  of  contagion.  Such  articles  as 
can  be  boiled  or  thoroughly  steamed  can  be  quite  well 
disinfected,  but  if  facilities  are  not  at  hand  for  steriliz- 
ing such  large  articles  as  mattresses,  they  may  need 
to  be  destroyed.  Boots,  hats,  and  certain  other  classes 
of  articles  will  not  stand  steaming  and  may  have  to  be 
disinfected  with  chemicals  or  destroyed,  though  in  most 
instances  exposure  of  them  to  the  sun  and  fresh  air  for 


204  THE  CAUSES   OF  DISEASE 

some  days  would  render  them  safe.  In  fact,  there  has 
accumulated  a  mass  of  evidence  to  show  that  terminal 
disinfection  of  houses  and  of  inanimate  things  in  gen- 
eral is  much  less  important  in  the  suppression  of  infec- 
tious disease  than  was  formerly  thought  to  be  the  case, 
though  prompt  disinfection  of  things  used  during  the 
actual  sickness,  such  as  spoons,  bedding,  and  utensils, 
is  thought  as  important  as  ever. 

Such  articles  of  personal  belongings  are  also  common 
carriers  of  the  organisms  of  suppuration.  So  widespread 
are  such  germs  that  almost  everything  in  common  use 
has  them  on  it ;  and  if  brought  into  contact  with  a 
wound  they  will  leave  the  article  and  start  infection. 
This  alone  makes  the  sterilized  and  sealed  first  •  aid 
packet  of  so  much  greater  value  than  articles  of  cloth- 
ing and  handkerchiefs  as  first  dressings  for  wounds. 
The  packets,  if  not  contaminated  by  handling,  practi- 
cally never  cause  infection ;  the  other  articles  almost 
always  do  so.  Nails,  bullets,  knives,  and  other  missiles 
or  weapons  that  have  not  been  sterilized  may  infect  the 
wounds  they  cause ;  or,  if  sterile  themselves,  may  carry 
infection  from  the  skin  or  clothing  they  traverse. 


PART  III 

THE  PREVENTION  AND  CONTROL 
OF  EPIDEMICS 


•'  Thou  sTiaU  not  he  afraid  .  .  .  for  the  pestilence  that  toalketh  in 
darkness :  nor  for  the  destruction  that  wasteth  at  noonday." 

Psalm  91 :  56 


CHAPTER  XI 

THE   DEFENSES   AGAINST    DISEASE    IN   GENERAL 

Fortunately  for  the  human  race,  the  contracting 
and  development  of  disease  are  somewhat  difficult  mat- 
ters, and  only  follow  the  occurrence  of  certain  trains 
of  circumstances.  They  may  be  compared  with  the  de- 
feat of  an  army,  for  which  purpose  it  is  necessary 
that  the  army  become  weakened  by  loss  of  men,  hard 
marching,  lack  of  food,  exposure,  or  some  other  cause ; 
or  that  the  enemy  has  been  able  to  bring  a  superior 
force  on  the  field,  that  his  supplies  are  better  or  are 
more  promptly  delivered  ;  that  one  side  improves  its 
opportunities  for  offense  or  defense  and  the  other  does 
not ;  or  that  other  good  and  sufficient  reasons  are  pre- 
sent. The  mere  existence  or  contact  of  two  armies  does 
not  explain  that  a  certain  one  of  them  is  defeated.  So 
in  the  matter  of  sickness,  the  mere  existence  or  contact 
of  a  man  and  typhoid  organisms  is  not  in  itself  suffi- 
cient to  insure  that  the  man  has  or  will  get  typhoid 
fever.  For  that  purpose  it  is  necessary  that  the  germs 
shall  be  alive,  virulent,  and  capable  of  development, 
that  they  shall  gain  entrance  to  the  body  of  the  man 
in  sufficient  numbers,  that  the  man's  body  shall  be 
unable  to  destroy  them  before  they  have  time  to  de- 
velop and  liberate  their  poisons,  and  that  his  tissues 
shall  unite  with  such  poisons  after  they  are  liberated. 
It  is  relatively  rare  that  these  conditions  coexist,  and 
typhoid  fever  is  therefore  not  more  common  than  it  is. 
Our  defense  against  sickness  then  rests  on  our  ability 


208       THE  PREVENTION  OF  EPIDEMICS 

to  break  or  destroy  the  chain  of  disease-favoriug  cir- 
cumstances. If  we  can  entirely  destroy  it,  we  are  sure 
to  remain  well,  but  if  we  cannot  do  that,  the  destruction 
of  one  link  may  save  us.  It  is  well,  therefore,  that  we 
should  first  consider  general  plans  of  defense  or  aggres- 
sion, and  later  pass  to  the  discussion  of  special  cam- 
paigns or  battles. 

The  body  is  defended  from  disease  by  many  natural 
factors,  and  we  should  try  to  preserve  these  intact.  The 

skin  presents  an  impassable  barrier  to  most 

Natural  .  a  c       •  *    *• 

^   ,  organisms,  and   very   tew   infections   can 

C6Z6I1S6S  . 

enter  through  it  as  long  as  it  remains  un- 
broken.  It  has  weak  points,  however,  and 
^  infections  may  occur  in  the  hair-follicles 

or  in  the  skiu-glands.  Boils  are  the  commonest  results 
of  such  invasions.  The  organisms  of  typhoid,  tubercu- 
losis, and  many  other  diseases  could  be  put  on  the 
sound  skin  with  impunity,  if  they  did  not  later  gain 
entrance  to  the  nose,  mouth,  wounds,  or  other  openings. 

The  mucous  membranes  are  all  warm  and  moist,  and, 
in  that  way,  offer  favorable  conditions  for  bacterial 
growth ;  but  they  are  all  covered  with  mucus  to  which 
the  germs  may  adhere,  and  with  which  they  may  be 
passed  out  of  the  body  by  spitting  or  otherwise.  The 
cells  lining  some  mucous  surfaces  have  little,  moving, 
hair-like  projections,  and  by  means  of  these  are  able  to 
pass  along  and  expel  small  foreign  bodies  getting  on 
them. 

The  gastric  juice  is  sufficiently  acid  to  destroy  many 
varieties  of  micro-organisms,  and  digestive  disturbances 
that  lessen  that  acidity  increase  the  liability  to  infec- 
tion. The  fluid  also  has  the  power  of  neutralizing  or 
digesting  some  poisonous  products,  but  not  all. 


DEFENSES  AGAINST  DISEASE  209 

The  urine,  by  its  acidity  and  its  irrigating  and 
cleansing  action,  doubtless  has  an  effect  in  keeping 
down  the  number  of  cases  of  venereal  diseases. 

The  prompt  reaction  to  in'itation  is  often  a  disease- 
preventing  factor.  A  dose  of  arsenic  or  a  meal  of  tainted 
meat  may  produce  such  prompt  vomiting  as  to  cause 
the  expulsion  of  all  poison,  and  so  prevent  further  symp- 
toms. The  inflammatory  reaction  following  the  infection 
of  wounds  is  usually  a  conservative  process  that  limits 
the  infection  to  the  locality  of  the  wound,  and  prevents 
its  diffusion  through  the  body. 

As  stated  before,  however,  a  man  may  possess  an 
immunity  to  certain  diseases  even  though  the  germs 
gain  entrance  to  his  body  in  the  numbers  Tjj.jj.„. 
and  of  the  virulence  ordinarily  producing  „■*_. 
such  diseases.  This  may  be  hereditary  or 
^^?iatnral"  immunity,  when  the  man  is  born  without 
susceptibility  to  the  disease.  It  is  acquired  when  due 
to  something  occurring  after  birth.  Acquired  immunity 
is  usually  due  to  an  attack  of  the  disease,  and  is  well 
recognized  in  such  affections  as  smallpox,  measles,  scar- 
latina, and  typhoid.  It  is  common  knowledge  that  one 
attack  of  any  of  these  usually  protects  against  a  second. 
This  is  also  known  as  active  immunity,  because  the 
body  is  active  in  maintaining  it.  Passive  immunity  is 
due  to  the  introduction  into  the  body  of  ready-made  im- 
munizing substances,  such  as  diphtheria  antitoxin,  that 
is  contained  in  the  blood-serum  of  an  immunized  horse. 
Active  acquired  immunity  may  also  be  induced  by 
vaccination,  the  procedure  whereby  disease-producing 
organisms  in  an  attenuated  or  weakened  state  are  intro- 
duced into  the  body  and  set  up  a  very  mild  form  of 
disease,  but  one  sufficient  to  set  the  body  on  the  de- 


210       THE  PREVENTION  OF  EPIDEMICS 

fensive  and  cause  it  to  produce  inamunizing  substancee. 
This  procedure  is  best  known  in  its  relation  to  small- 
pox, and  as  that  was  the  disease  for  whose  prevention  it 
was  first  used,  the  name  vaccination  in  the  broad  sense, 
that  is,  the  introduction  of  disease-producing  germs  to 
produce  immunity,  is  taken  from  that  instance.  It  has 
also  been  used,  though,  to  produce  immunity  to  cholera, 
plague,  dysentery,  typhoid  fever,  hydrophobia,  and  sev- 
eral diseases  of  animals,  in  some  instances  with  consid- 
erable success. 

Immunity  may  also  be  relative  or  absolute,  temporary 
or  permanent.  Man's  lack  of  susceptibility  to  the 
pleuro-pneumonia  of  cattle,  for  instance,  is  hoth  perma- 
nent and  absolute.  An  attack  of  smallpox  may  produce 
an  immunity  that  is  either  2)ei'manent  or  temporary.  In 
the  latter  instance  the  sufferer  might  have  a  second 
attack  after  some  years.  A  relative  immunity  to  typhoid 
might  protect  against  a  small  number  of  bacteria,  but 
not  against  a  very  large  number.  Relative  immunity 
partially  protects  races  long  resident  in  malarious  re- 
gions from  the  more  severe  or  urgent  manifestations 
of  that  disease.  This  particular  form  of  it  is  probably 
partly  acquired  as  the  result  of  the  prolonged  exercise 
by  the  body  of  its  resisting  powers,  and  partly  inherited 
and  due  to  the  survival  of  the  more  resistant  individu- 
als and  the  transmission  to  their  progeny  of  their  re- 
sistant qualities.  In  most  highly  malarious  regions  the 
natives  are  practically  all  infected,  yet  they  appear  to 
be  in  fair  health,  but  foreigners  going  among  them  are 
apt  to  be  attacked  by  malaria  in  its  most  severe  and 
dangerous  forms. 

Immunity  is  due  to  several  factors,  not  all  of  which 
are  understood.   In  regard  to  some  diseases,  such  as 


DEFENSES  AGAINST  DISEASE  211 

diphtheria  and  tetanus,  it  is  due  to  the  development  of 
antitoxin,  a  substance  that  acts  as  a  direct  antidote  to 
the  poison  of  the  disease  and  neutralizes  its  effects.  In 
other  instances,  as  in  the  case  of  plague,  cholera,  and 
typhoid,  it  is  largely  due  to  the  presence  or  develop- 
ment of  substances  that  kill  or  dissolve  the  bacteria. 
It  is  probable  that  it  is  often  due  to  the  ability  of  the 
tissues  to  digest  thoroughly  the  protein  of  the  bacterial 
bodies  and  render  it  harmless,  as  discussed  on  the  last 
page  of  chapter  ix.  In  many  instances  it  is  partly  or 
entirely  due  to  the  activity  of  certain  cells,  phagocytes, 
that  take  up  and  destroy  the  germs.  Absolute  hereditary 
immunity  may  be  due  to  none  of  these,  but  to  lack  on 
the  part  of  the  body  cells  of  chemical  groups  that  enable 
the  poisons  to  enter  into  combination  with  them. 

Ilelative  immunity  is  maintained  by  those  conditions 
that  keep  up  the  general  health  and  maintain  the  re- 
sistance of  the  body.  It  is  lowered  by  causes     -,  - 
that  depress  these,  such  as  starvation,  ex-     __     -  , 
haustion,  injuries,  shocks,  worry,  and  grief. 
It  is  therefore  important  that  the  man  and  his  environ- 
ment be  constantly  kept  at  their  best,  that  abundant 
and  proper  food,  pure  water,  good  air,  and  right  clothing 
be  provided,  that  sufficient  exercise  to  keep  the  respira- 
tion, circulation,  digestion,  and   excretion    active  be 
taken;  that  overwork,  improper  food,   alcoholic  and 
venereal  excesses,  and  the  entire  list  of  things  predis- 
posing to  disease  be  avoided. 

All  of  these  measures  tend  to  strengthen  the  man 
and  put  him  in  good  condition  and  position  for  the 
combat  with  disease ;  and,  as  with  armies,  so  in  this  in- 
stance, the  maintenance  and  strengthening  of  our  own 
forces  is  not  less  important  than  the  weakening  or  bin- 


212       THE  PREVENTION  OF  EPIDEMICS 

dering  of  the  enemy  ;  and  as  the  possession  of  a  large 
and  well-trained  army  is,  in  these  days,  often  spoken  of 
as  a  "national  insurance  policy"  and  a  guarantee  of 
peace,  so  may  the  well-trained  and  sound  body  be  re- 
garded as  insurance  against  disease.  As  the  combat  with 
germs  is,  however,  one  that  never  ceases,  we  must  also 
try  to  injure  the  enemy  as  much  as  possible,  giving 
no  quarter,  as  we  may  expect  none.  We  should  try  to 
eradicate  all  disease-producing  organisms,  to  reduce 
their  numbers  where  we  cannot  do  that,  and  to  weaken 
them  by  every  means  available.  Many  of  the  measures 
designed  to  accomplish  these  ends  have  been  mentioned 
or  discussed  in  preceding  chapters  or  will  be  taken  up 
more  fully  in  later  ones,  but  some  of  them  may  be  con- 
sidered at  length  here  and  not  again  described.  They 
may  be  classed  in  two  categories :  measures  designed  to 
prevent  contact  with  the  germs,  and  those  aimed  at 
their  destruction. 

Among  the  former,  avoidance  of  the  sick  may  be 
considered  one  of  the  most  important  measures.    This 
recommendation  cannot  be  taken  as  coun- 
tenancing neglect  of  the  sick  or  lack  of  all 
ance  of  i  •       ^       •       r 

e-  1-  proper  care  and  attention,  but  it  refers  to 

unnecessary  contact  with  them,  that  due 
to  carelessness,  curiosity,  or  sentimentality.  As  stated 
before,  the  principal  agent  in  the  dissemination  of 
human  diseases  is  man  himself,  and  nearly  every  case  of 
infectious  disease  is  derived  from  another.  Therefore, 
unnecessary  visits  to  hospitals  and  sick-rooms  should  be 
discouraged,  and  in  military  life  it  should  be  axiomatic 
that  sick  men  should  be  removed  from  squad-rooms,  un- 
less good  reasons  to  the  contrary  exist  in  special  cases. 
Even  though  the  sick  man  goes  into  a  general  ward 


DEFENSES  AGAINST  DISEASE  213 

in  the  hospital,  he  is  less  apt  to  infect  others  there  for 
several  reasons.    One  of  these  is  that  air-     __     ^. 
space  and  ventilation  are  more  liberal  there.     ^ 
In  the  squad-room,  where  but  six  hundred 
cubic  feet  of  space  are  allowed  each  person,  a  sick  man 
may  seriously  contaminate  the  air.  In  hospital  the  same 
amount  of  contagium  is  dilated  two  to  four  times,  be- 
cause the  space  per  man  is  twelve  to  twenty-four  hun- 
dred cubic  feet.  Naturally  an  exposed  person  breathes 
in  only  one  third  as  many  organisms.  Precautions  are 
also  taken  in  hospital  to  reduce  the  chances  of  mediate 
contact. 

In  the  more  readily  transmissible  diseases  isolation  is 
resorted  to  as  a  means  of  insuring  lack  of  contact.  For 

this  reason  it  is  highly  important  in  such  ,     , 

LL     J.  ^  •     li   T  11  1  .  Isolation 

"catching     diseases  as   smallpox,  scarlet 

fever,  and  measles,  and  is  of  value  in  the  management 
of  typhoid  and  most  other  infectious  diseases.  Both  the 
character  and  the  duration  of  the  isolation  vary  in  dif- 
ferent diseases,  according  to  the  methods  and  ease  of 
transmission  and  the  duration  of  the  infectious  period. 
Typhoid  and  many  other  infections  can  be  safely  iso- 
lated in  a  room  or  even  in  a  general  ward,  if  proper 
care  is  taken  in  the  disposal  of  excreta,  bath-water,  and 
other  waste  material,  in  the  exclusion  of  flies  and  ver- 
min, and  in  the  prevention  of  mediate  contact  and  the 
prompt  and  careful  disinfection  of  the  means  of  such 
contact,  such  as  bedding,  utensils,  thermometers,  unused 
foods,  nurses'  hands,  etc.  Such  care  may  be  necessary 
for  weeks  or  months.  It  is  usually  considered  necessary 
to  isolate  smallpox  cases  in  a  separate  house  or  tent, 
removed  from  other  houses,  and  to  continue  the  isola- 
tion until  the  patient  is  well.  The  contagion  of  measles 


214       THE  PREVENTION   OF  EPIDEMICS 

is  so  readily  transmissible  that  isolation  would  seem 
very  important,  but  the  period  of  contagiousness  comes 
so  early  in  the  disease  that  isolation  is  not  effective,  be- 
cause it  is  not  applied  soon  enough.  In  yellow  fever, 
malaria,  and  dengue  the  degree  of  isolation  is  not  neces- 
sarily greater  than  that  afforded  by  the  screening  re- 
quired to  exclude  mosquitoes  from  the  sick,  while  in 
typhus  and  European  relapsing  fever,  both  formerly 
considered  so  highly  contagious,  it  is  only  necessary  to 
keep  lice  from  the  patient  and  his  visitors. 

Infectious  diseases  of  various  kinds  have  different 
incubation  periods.  These  represent  the  time  elapsing 
-^  between  the  occurrence  of  infection,  the 

^  entrance  of  the  germs  into  the  body,  and 

the  appearance  of  the  disease.  In  some  cases 
of  cholera,  diphtheria,  and  a  few  other  diseases,  the  in- 
cubation period  may  be  as  short  as  one  day  or  a  few 
hours ;  while  in  hydrophobia  it  may  extend  many  weeks 
and  possibly  months.  Diseases  also  vary  as  to  length 
of  time  during  which  the  subjects  remain  sources  of 
danger  after  their  apparent  recovery.  Yellow  fever, 
for  instance,  ceases  to  be  dangerous,  to  others  than  the 
patient,  after  the  third  day  of  its  existence ;  while  a 
typhoid  patient  may  continue  to  give  off  immense  num- 
bers of  virulent  organisms  and  constitute  a  source  of 
danger  to  the  community  for  many  years. 

The  term  quarantine,  though  used  in  several  senses, 
the  oldest  meaning  a  forty-day  period  of  isolation  for 
persons  thought  to  be  possible  subjects  of  disease,  is 
now  most  commonly  used  to  indicate  the  separation  from 
the  general  community  of  persons  presumably  exposed 
to  infectious  disease,  and  observation  of  them  during 
the  period  of  incubation  of  the  disease  in  question.   In 


DEFENSES  AGAINST  DISEASE  215 

practice  the  term  is  also  used  to  cover  the  isolation  of 
the  sick.  Employed  rationally  and  under  sound  medi- 
cal advice,  quarantine  is  often  a  valuable  measure  and 
may  prevent  epidemics.  It  is  one  of  our  main  reliances 
in  excluding  plague,  cholera,  and  many  other  diseases 
from  our  ports. 

But  it  is  always  attended  with  hardship  to  its  sub- 
jects, and  when  controlled  by  laymen  actuated  by 
panic,  fear,  or  malice,  it  may  become  an  instrument  of 
cruelty  and  oppression.  Only  trained  medical  officers 
should  direct  or  control  systems  of  quarantine,  and  their 
training  should  be  relied  upon  to  suit  the  system  to 
the  circumstances.  A  fixed  isolation  period,  say  of  one 
month,  for  yellow  fever  and  scarlet  fever,  would  be 
wrong  in  both  instances,  but  in  the  one  the  patient 
would  be  unjustly  treated,  in  the  other,  the  public. 

In  addition  to  the  matters  of  barrack,  camp,  and 
kitchen  police  already  discussed,  larger  schemes  of  po- 
licing or  engineering  are  important  in  the   p-j^^- 
prevention  of  disease.  These  embrace  such         ,  _ 

diverse  measures  as  the  construction  of  fil-    ^.„^^  .^^ 
,  -  p      .  1    gmeenng 

termg  plants  and  water-systems  to  furnish   Trr-Qj-tg 

an  abundance  of  pure  water,  the  installation 
of  sewerage-systems  and  crematories  for  the  removal  or 
destruction  of  waste,  thorough  policing  and  cleaning  of 
streets  and  neighborhoods  to  keep  down  dust  or  reduce 
vermin,  or  the  draining,  filling,  or  oiling  of  marshes  to 
do  away  with  mosquitoes. 

The  best  known  and  most  commonly  employed  mea- 
sures for  killing  germs  are  usually  spoken  of  as  disin- 
fection and  sterilization.  The  terms  are  not  synony- 
mous, though  often  used  as  if  they  were.  When  an 
article  is  sterile  in  thp  bacteriological  sense,  it  is  free 


216        THE  PREVENTION   OF  EPIDEMICS 

from  all  germs.    Disinfection   may  free   it   from   all 

_..  .    ,  germs,  but  does  not  necessarily  do  so.   It 

,     means  the  destruction  of  infectious  organ- 

g,      ...         isms.   A   urinal  or   bedpan   contaminated 

^  by  use  by  a  typhoid  patient  might  be  dis- 

infected by  simply  rinsing  in  hot  water,  as 
the  typhoid  germs  are  killed  in  a  few  minutes  by  a  tem- 
perature of  70°  C.  It  would  certainly  not  be  sterile. 

Heat  is  the  most  reliable  of  the  means  of  sterilization 
of  small  inanimate  objects.  It  may  be  applied  moist  or 
dry,  the  former  effective  at  much  lower  degrees  than 
the  latter.  Boiling  water  or  streaming  steam,  both  of 
which  have  a  temperature  of  100  C,  will  destroy  all 
kinds  of  growing  germs  in  a  short  time,  while  dry  heat 
of  200°  C.  is  necessary  to  accomplish  the  same  purpose. 
As  this  temperature  will  burn  fabrics  and  is  dangerous, 
it  is  not  much  used.  Boiling  is  simple  and  is  easily  ap- 
plied to  small  articles,  so  that  it  is  commonly  resorted 
to  where  special  appliances  are  not  available.  In  hos- 
pitals steam  sterilization  is  more  often  resorted  to,  as 
being  more  convenient  and  not  necessitating  so  much 
handling  and  drying  of  articles.  Large  institutions  also 
have  steam-chests  of  sufficient  size  to  receive  such  bulky 
articles  as  mattresses,  carpets,  and  other  household  fur- 
nishings, which  may  thus  be  quickly  and  thoroughly 
disinfected.  Gases  and  solutions  of  chemicals  are  also 
used  for  disinfecting ;  the  former  for  rooms,  furnishings, 
or  clothing  that  would  be  injured  by  heat,  and  to  pene- 
trate into  cracks  and  crevices  not  otherwise  accessible. 
As  many  of  these  substances  possess  disagreeable  odors, 
or  have  the  property  of  destroying  smells,  the  lay  public 
at  times  displays  a  tendency  to  confuse  deodoriza- 
tion  and  fumigation  with  disinfection.    The  three  may 


DEFENSES  AGAINST  DISEASE  217 

coexist,  but  they  are  not  the  same,  and  the  words 
should  not  be  used  loosely,  as  such  usage  may  lead  to 
confusion  of  the  processes  and  so  do  harm.  Charcoal  is  a 
good  deodorant,  and  burning  tobacco  or  pyrethrum  may 
furnish  efficient  fumigation  in  ridding  a  house  of  mos- 
quitoes, but  none  of  these  is  disinfectant.  The  principal 
gaseous  disinfectants  are  chlorine,  sulphur  fumes,  and 
formaldehyde.  All  of  them  are  very  irritant  and  un- 
suitable for  use  in  efficient  concentration  in  rooms  or 
places  where  they  will  be  inhaled. 

Chlorine  is  not  commonly  used  in  its  gaseous  state, 
and  when  "chloride  of  lime"  is  sprinkled  about  it  is 
liberated  in  such  small  amoumts  as  to  be  inefficient.  In 
watery  solution  it  is  valuable  in  disinfecting  surfaces  to 
which  it  can  be  applied.  It  is  a  powerful  bleaching 
agent,  and  cannot  be  used  on  fabrics.  Of  recent  years 
this  substance  has  come  into  very  wide  use  as  a  purifier 
of  water.  Many  cities  use  it,  and  its  use  by  troops  in 
the  field  has  already  been  discussed. 

Burning  sulphur  gives  off  fumes  which  unite  with 
water  to  form  sulphurous  acid,  a  very  efficient  disin- 
fectant. The  dry  fumes  have  very  little  virtue  of  the 
kind,  but  are  very  useful  in  destroying  vermin,  such  as 
flies,  mosquitoes,  and  rats.  When  it  is  desired,  however, 
to  disinfect  a  room  that  has  been  occupied  by  a  case 
of  contagious  disease,  such  as  scarlet  fever,  by  means  of 
sulphurous  fumes,  the  walls,  floors,  and  other  surfaces 
should  first  be  moistened  by  wiping  them  with  a  damp 
rag,  or  in  some  other  way.  As  sidphurous  acid  also 
bleaches  or  fades  fabrics,  it  is  frequently  not  to  be  used 
except  at  great  expense. 

Formaldehyde  gas,  or  its  forty  per  cent  solution  in 
water,  known  as  formal  or  formalin,  is  now  more  often 


218       THE  PREVENTION  OF  EPIDEMICS 

used  than  any  other  gaseous  disinfectant.  The  gas  may 
be  generated  in  the  room  to  be  disinfected  by  burning 
wood  alcohol  in  special  burners  known  as  formaldehyde 
generators,  or  it  may  be  liberated  by  the  evaporation  of 
formalin.  The  latter  is  a  very  simple  procedure,  and 
while  its  effectiveness  cannot  be  guaranteed,  the  same 
may  be  said  of  other  gaseous  disinfection,  and  it  is 
often  the  best  available  means.  Many  methods  of  for- 
maldehyde disinfection  have  been  used,  but  only  the  use 
of  formalin  will  be  described  here.  For  disinfecting  the 
contents  of  trunks  and  boxes,  it  may  be  sprinkled  over 
them  freely,  or  placed  on  absorbent  cotton  or  blotting- 
paper  and  the  boxes  then  closed  tightly  for  twenty- 
four  hours.  For  the  disinfection  of  rooms,  from  four 
ounces  to  a  pint  of  formalin  should  be  used  for  each 
thousand  feet  of  cubic  contents.  The  gas  is  speedily 
liberated  if  six  ounces  of  permanganate  of  potash  be 
added  to  the  pint  of  formalin  in  a  large  bowl,  or  if 
unslaked  lime  be  added,  or  if  the  fluid  be  poured  on 
hot  bricks.  A  still  simpler  and  quite  efficient  method, 
however,  is  to  close  hermetically  all  cracks  and  crevices 
about  the  room,  stretch  ropes  or  strings  across  it  and 
on  them  hang  sheets.  The  formalin  is  then  poured  upon 
the  sheets  to  saturate  them,  and  the  room  tightly  closed 
and  kept  so  for  twenty-four  hours  or  more,  after  which 
it  should  be  well  opened  and  aired,  to  rid  it  of  all  fumes. 
None  of  the  gaseous  disinfectants  can  be  depended 
upon  to  penetrate  thoroughly  into  large  and  thick  arti- 
cles such  as  mattresses.  Their  action  is  apt  to  be  super- 
ficial, and  it  is  therefore  important  that  the  articles  in  a 
room  to  be  disinfected  be  disposed  in  such  a  manner  as 
to  expose  as  much  surface  as  possible.  Bedding  should 
be  taken  out  of  piles  and  hung  on  ropes  or  racks,  pic- 


DEFENSES  AGAINST  DISEASE  219 

tures  removed  from  walls,  books  opened  so  as  to  expose 
all  pages  if  possible,  pockets  turned  inside  out,  and  all 
boxes  opened. 

Formaldehyde  is  less  harmful  to  fabrics  and  colors 
than  the  other  gaseous  disinfectants,  and  is  altogether 
the  most  satisfactory  for  ordinary  use,  except  that  it 
cannot  be  depended  upon  to  kill  insects  and  vermin. 

Fluid  and  solid  chemicals,  the  latter  in  solution,  are 
much  used  as  germicides^  disinfectants^  or  antiseptics. 
The  number  of  substances  so  used  is  large,  some  of  the 
more  important  of  them  being  the  various  acids,  per- 
manganate  of  potash,  peroxide  of  hydrogen,  and  those 
to  be  discussed. 

Bichloride  of  mercury,  or  corrosive  sublimate,  is 
probably  the  most  important,  and  for  many  purposes 
the  most  valuable,  antiseptic  drug.  It  is  used  in  watery 
solution  of  various  strengths.  A  solution  as  weak  as 
one  part  in  one  million  has  some  value,  but  it  is  gener- 
ally used  in  strengths  varying  from  one  part  in  five  hun- 
dred to  one  in  five  thousand,  and  in  such  dilution  is  a 
very  powerful  antiseptic,  killing  most  germs  in  a  few 
minutes.  It  has  attained  popularity,  and  is  commonly 
sold  in  tablets  of  such  size  that  one  added  to  a  pint  of 
water  makes  a  one  to  one  thousand  solution.  The  main 
objections  to  bichloride  are  that  it  is  a  powerful  and 
deadly  poison,  and  the  tablets  in  which  it  is  sold  may, 
by  mistake,  be  taken  for  other  substances ;  and  that  it 
corrodes  and  injures  metals  with  which  it  may  come  in 
contact.  It  works  more  efficiently  when  combined  with 
an  acid,  and  the  tablets  are  usually  such  combinations. 

Carbolic  acid,  or  phenol,  is  quite  as  well,  if  not  better, 
known  as  an  antiseptic.  It  is  not  so  powerful  as  bichlo- 
ride, and  is  used  in  solution  of  from  one  to  five  per  cent 


220       THE  PREVENTION  OF  EPIDEMICS 

strength.  Occasionally  it  is  used  in  what  is  called  its 
"  pure  "  form,  about  ninety-five  per  cent  strength.  It  is 
a  very  deadly  poison,  but  it  does  not  corrode  metals  as 
does  bichloride,  and  is  therefore  better  for  disinfecting 
them.  Both  of  these  substances  irritate  and  injure  the 
bands  if  much  used. 

Iodine  has  long  been  known  as  an  efficient  disin- 
fectant and  antiseptic,  but  it  has  grown  in  favor  very 
rapidly  in  the  last  few  years  and  is  now  particularly 
esteemed  for  use  in  disinfecting  the  skin  or  the  sur- 
faces of  wounds,  for  which  purpose  the  tincture  is  gen- 
erally used. 

"  TrikresoV^  is  a  disinfectant  that  is  supplied  and 
much  used  in  our  military  service.  It  is  less  readily  sol- 
uble than  phenol,  but  is  equally  as  powerful  a  disin- 
fectant when  used  in  half  the  strength  of  the  solution 
of  the  latter.  It  also  is  a  poison. 

There  are  numbers  of  mixtures  or  emulsions  made 
with  cresols  or  crude  carbolic  as  bases,  which  are  both 
cheap  and  excellent  for  many  purposes.  Many  of  them, 
like  the  Creolin  issued  among  veterinary  supplies,  are 
proprietary  preparations  and  are  sold  under  trade 
names.  As  cheap,  efficient,  and  not  secret  in  composi- 
tion may  be  mentioned  the  official  compound  cresol  so- 
lution and  the  "  larvacide  "  used  on  the  Panama  Canal 
to  destroy  mosquito  larvae  and  as  a  disinfectant. 

Formalin  is  also  used  as  a  liquid  disinfectant,  and 
for  some  purposes,  such  as  the  disinfection  of  urine 
and  feces,  it  is  probably  the  most  valuable  one  we  have. 
It  should  be  thoroughly  mixed  with  a  stool  to  be  dis- 
infected, lumps  of  feces  broken  up,  and  the  two  allowed 
to  stand  in  contact  for  a  time.  Formalin  is  also  a  val- 
uable deodorizer. 


DEFENSES  AGAINST  DISEASE  221 

For  a  few  diseases  we  have  remedies  that  may  be 
termed  specific,  or  truly  curative.  In  most  infectious 
diseases,  however,  we  are  at  best  able  to 
modify  the  course  of  the  affection,  to  re- 

ClUGS 

lieve  symptoms  and  maintain  the  strength 
and  vitality  until  nature,  or  the  body  forces,  accom- 
plishes a  cure ;  and  even  the  specifics  cannot  always  be 
«:iven  in  such  a  way  that  they  get  at  and  destroy  all 
the  organisms  of  disease. 

Quinine  is  a  specific  for  malaria,  and  actually  de- 
stroys the  growing  and  multiplying  organisms  in  the 
blood.  Yet  men  occasionally  die  of  malaria  in  spite  of 
quinine,  and  many  hundreds  of  army  men  can  testify 
that  quinine  does  not  always  effect  a  prompt  and  per- 
manent cure  of  the  disease. 

Mercury  is  a  specific  for  syphilis.  It  kills  the  organ- 
isms causing  the  disease,  and  causes  the  lesions  to  heal; 
yet  the  men  who  have  devoted  the  most  attention  and 
study  to  the  subject  agree  that  treatment  must  be  con- 
tinued from  two  to  four  years  in  order  to  assure  a  cure. 

The  drug  kuown  as  "  salvarsan  "  or  "  606^'^  which 
was  introduced  a  few  years  ago  as  a  specific  for  syph- 
ilis, is  actually  such,  and  it  destroys  the  causative  or- 
ganisms with  great  rapidity.  However,  it  is  apparently 
unable  to  reach  them  all,  and  world-wide  use  of  it, 
while  proving  its  value,  has  only  destroyed  the  hope  at 
one  time  cherished,  that  one  injection  could  be  depended 
upon  to  cure  the  disease. 

Antitoxin  is  a  specific  for  diphtheria,  neutralizing 
the  poison  and  making  it  harmless.  Yet,  if  it  be  not 
given  early  and  the  toxin  has  a  chance  to  unite  with  the 
tissues,  it  may  fail,  and  death  result  in  spite  of  its  use. 

Altogether,  the  consideration  of  specific   remedies 


222       THE  PREVENTION  OF  EPIDEMICS 

cannot  but  convince  us  that  the  prevention  of  disease 
is  of  much  more  importance  and  value  than  its  treat- 
ment, and  that  the  tendency,  often  manifested,  to  regard 
the  medical  officer  as  one  whose  main  office  is  the  treat- 
ment of  men  already  sick,  one  who  should  have  nothing 
to  do  with  the  general  administration  of  a  post  or  an 
army,  is  a  very  grave  mistake.  Specifics  are  very  valu- 
able, however,  in  the  prevention  of  disease.  Mosquitoes 
are  not  apt  to  obtain  infection  from  the  blood  of  men 
taking  quinine.  The  man  who  is  under  treatment  for 
syphilis  is  less  apt  to  transmit  it  than  the  infected  man 
who  is  untreated,  and  the  prompt  use  of  mercurial 
inunctions  after  intercourse  has  been  shown  to  be  of 
value  in  the  prevention  of  infection.  "  Fourth  of  July  " 
tetanus,  at  one  time  all  too  common,  was  very  greatly 
reduced  by  the  routine  use  of  tetanus  antitoxin  after 
injuries  caused  by  fireworks. 


CHAPTER  XII 

DISEASES   DUE  TO   INFECTION  THROUGH  THE 
ALIMENTARY  TRACT 

Typhoid  and  para-typhoid  fevers,  cholera,  dysentery, 
and  "  camp  diarrhcea,"  which  is  apt  to  be  typhoid  or 
dysentery,  may  be  conveyed  in  other  ways  than  are  in- 
dicated by  the  heading  of  this  chapter.  Typhoid,  for 
instance,  may  be  produced  by  injection  of  the  living 
organisms  beneath  the  skin.  In  general,  though,  these 
diseases  come  from  the  ingestion  of  the  causative  or- 
ganisms by  way  of  the  alimentary  canal.  The  germs 
are  in  the  vast  majority  of  instances  introduced  in  or 
on  food  or  drink.  For  many  years  water  was  considered 
the  principal  medium  for  the  introduction,  and  it  is  still 
recognized  as  a  very  important  factor.  Of  late  years, 
however,  so  many  cases,  and  even  large  epidemics,  have 
been  traced  to  infected  foods  and  so  many  more  to  con- 
tact that  it  is  really  considered  misleading  to  speak  of 
these  merely  as  "  water-borne  "  diseases. 

In  addition  to  the  acute  infections  mentioned  above, 
there  are  a  number  of  others  that  enter  by  the  same 
route.  Tuberculosis  does  so  at  times,  possibly  in  a  large 
proportion  of  cases ;  many  "  acute  food  poisonings  "  are 
properly  alimentary  tract  infections ;  "  milk  sickness  '* 
is  due  to  infection  with  germs  contained  in  milk  from 
diseased  cows ;  Malta  fever  to  germs  in  the  milk  of 
goats  infected  with  that  disease ;  infestations  with  many 
varieties  of  intestinal  worms  occur  by  way  of  the  mouth, 
and  some  of  the  diseases  to  be  later  described  as  enter- 


224       THE   PREVENTION   OF   EPIDEMICS 

ing  by  way  of  the  respiratory  tract,  such  as  diphthei'ia, 
are  known  to  be  carried  in  infected  milk.  It  is  conceiv- 
able, though  doubtless  uncommon,  that  typhoid  or  chol- 
era organisms  may  enter  the  body  through  inhalation, 
and  in  the  throat  pass  to  the  alimentary  tract  and  be 
swallowed.  In  fact  the  throat,  where  diphtheria,  scarlet 
fever,  and  a  number  of  other  infections  are  apt  to  local- 
ize, is  common  to  both  the  alimentary  and  the  respira- 
tory tracts,  and  it  is  not  always  possible  to  say  by  which 
tract  an  infection  enters.  However,  it  is  generally  cor- 
rect to  speak  of  the  diseases  here  discussed  as  entering 
by  the  alimentary  tract,  and  it  has  been  found  in  prac- 
tice that  the  other  avenues  may  be  neglected  without 
great  danger. 

These  have  always  constituted  a  very  important  group 
of  diseases,  particularly  for  military  men,  and  in  ancient 
and  modern  times,  an<l  in  all  of  our  wars,  clear  down 
to  and  including  the  war  with  Spain  and  the  later  Phil- 
ippine insurrection,  typhoid  and  dysentery  did  more 
damage  than  did  hostile  arms.  As  our  knowledge  in  re- 
gard to  them  has  grown  and  we  have  learned  of  their 
causes  and  the  subtle  and  manifold  methods  of  trans- 
mission, we  have  been  more  and  more  able  to  avoid 
them,  and  if  they  ever  again  cause  such  morbidity  as  they 
have  in  the  past,  it  will  be  because  of  neglect  or  of  cir- 
cumstances beyond  control,  and  not  because  of  igno- 
rance. As  showing  how  great  a  scourge  typhoid  has 
been  to  us  even  in  recent  years,  and  after  the  method 
of  water  carriage  of  the  disease  was  well  understood, 
may  be  quoted  the  official,  and  it  is  thought  conserva- 
tive, statement  that  "  About  one  fifth  of  the  soldiers  in 
the  national  encampments  in  the  United  States  in  1898 
developed  typhoid  fever.  Among  107,973  officers  and 


ALIMENTARY  TRACT  INFECTION        225 

men  in  92  regiments,  the  records  of  which  we  have  care- 
fully studied,  the  number  of  cases  of  typhoid  fever, 
according  to  our  estimates,  was  20,738."  The  above 
is  from  the  report  of  the  "  Board  on  the  Origin  and 
Spread  of  Typhoid  Fever  in  United  States  Military 
Camps  during  the  Spanish  War  of  1898,"  of  which 
board  the  late  Major  Walter  Reed  was  president.  That 
report  gave  an  impetus  to  the  investigations  that  have 
since  so  greatly  increased  our  knowledge  of  the  disease 
and  of  the  means  of  preventing  it  as  to  give  rise  to  the 
lively  hope  that  such  conditions  as  the  board  investi- 
gated may  never  recur.  Nevertheless  cholera,  which  is 
equally  well  understood  and  preventable,  did  great 
damage  to  troops  so  recently  as  the  late  war  in  the 
Balkans. 

Typhoid  fever*  will  be  taken  as  the  type  disease  for 
this  chapter,  because  it  has  been  of  such  great  military 
importance  in  our  own  service,  and  because  it  has  so 
recently  been  almost  eliminated  from  that  service,  and 
it  may  well  serve  as  a  striking  object  lesson  in  hygiene, 
but  the  general  statements  made  are  applicable  to  the 
other  infections  that  are  transmitted  in  a  similar  manner. 

The  exciting  causes  of  these  diseases  are  as  follows; 
Typhoid  fever  is  caused  by  a  bacillus  that  is  found  in 
the  bowels,  gall-bladder,  blood,  and  internal     -, 
organs  of  those  having  the  disease.    It  is 
an   actively  mobile  organism,  does  not  form  spores, 
is  easily  killed  by  heat,  and  does  not,  under  natural 

^  Para-typhoid,  of  which  at  least  two  yarieties  exist,  haa  only  been 
separated  from  typhoid  for  a  few  years,  and  even  now  the  diagnosis 
rests  entirely  on  the  identification  of  the  causative  bacilli,  which  in  turn 
bear  a  close  resemblance  to  one  another.  For  this  reason  most  statistics 
and  descriptions  of  typhoid  also  include  para-typhoid. 


226       THE  PREVENTION  OF  EPIDEMICS 

conditions,  produce  disease  in  other  animals  than  man. 
Cholera  is  caused  by  a  vibrio  or  spirillum,  a  spiral  bac- 
terium that  occurs  in  the  intestinal  discharges  and  con- 
tents of  persons  having  the  disease.  It  is  actively  mobile, 
multiplies  with  great  rapidity,  and  in  so  doing  the 
spirals  break  into  comma-shaped  fragments,  whence  the 
name  comma  bacillus.  It  does  not  form  spores,  is  easily 
killed  by  heat  and  acids,  and  succumbs  to  the  action  of 
sunlight  more  promptly  than  most  other  organisms. 
Dysentery  is  a  name  applied  to  a  group  of  symptoms 
rather  than  to  one  specific  disease.  Consequently  it  is 
due  to  several  causes.  One  class  of  cases  is  caused  by 
a  group  of  closely  related  bacilli  that  present  some 
differences,  another  to  an  amoeba,  an  animal  parasite, 
and  still  others  to  other  microscopic  animal  parasites. 
Intestinal  infestations  with  worms  have  already  been 
discussed. 

Every  case  of  any  of  these  diseases  is  derived  from 
some  other  case.  We  may  at  times  have  great  difficulty 
Q  .   .  in  tracing  the  origin  of  given  cases,  but  the 

,  „   .         more  we  learn  about  the  diseases  the  more 
J       .  evident  the  truth  of  the  preceding  sentence 

becomes.  Diet  and  unsanitary  conditions 
promote  the  spread  of,  but  cannot  originate,  typhoid. 
The  germs  must  be  introduced  by  man  and  are  so  in- 
troduced. The  man  who  first  brings  infection  to  a  camp 
may  have  the  fever  and  not  know  what  is  the  matter ; 
he  may  be  recovering  from  it  and  still  not  know,  or  he 
may  have  had  it  and  recovered  long  before,  but  be  a 
*'  carrier  "  and  continue  excreting  bacilli  for  years.  As 
showing  the  prevalence  of  typhoid  fever  in  the  general 
population  of  the  United  States  in  1898,  the  following 
conclusions  of  the  Reed  Board  are  of  great  interest :  — 


ALIMENTARY  TRACT  INFECTION        227 

"  (1.)  During  the  Spanish  War  of  1898  every  regi- 
ment constituting  the  First,  Second,  Third,  Fourth, 
Fifth,  and  Seventh  Army  Corps  developed  typhoid 
fever. 

'*  (2.)  More  than  ninety  per  cent  of  the  volunteer 
regiments  developed  typhoid  fever  within  eight  weeks 
after  going  into  camp. 

"  (3.)  Typhoid  fever  developed  also  in  certain  regu- 
lar regiments  within  three  to  five  weeks  after  going  into 
camp. 

"  (4.)  Typhoid  fever  became  epidemic  both  in  the 
small  encampments  of  not  more  than  one  regiment  and 
in  the  larger  ones  consisting  of  one  or  more  corps. 

"(5.)  Typhoid  fever  became  epidemic  in  camps 
located  in  the  Northern  as  well  as  in  those  located  in 
the  Southern  States. 

"  (6.)  Typhoid  fever  is  so  widely  distributed  in  this 
country  that  one  or  more  cases  are  likely  to  appear  in 
any  regiment  within  eight  weeks  after  assembly. 

"  (7.)  Typhoid  fever  usually  appears  in  military  ex- 
peditions within  eight  weeks  after  assembly." 

Because  of  increase  of  knowledge  of  the  methods  of 
transmission,  and  the  dissemination  of  that  knowledge 
by  state  and  local  boards  of  health,  by  doctors,  socie- 
ties, magazines,  and  newspapers,  because  of  improved 
water  supplies,  sewage  disposal,  anti-fly  campaigns,  and 
other  advances  since  that  time,  it  is  probable  that  the 
general  conditions  are  not  nearly  so  bad  as  they  were 
then,  while  experience  has  demonstrated  that  introduced 
typhoid  is  not  now  allowed  to  spread  as  it  then  did.  The 
improvement  in  general  conditions  is  not  limited  to  our 
own  country,  nor  do  we  lead  in  it.  In  fact,  we  have  been 
behind  both  England  and  Germany  in  much  public  health 


228       THE  PREVENTION   OF  EPIDEMICS 

work,  and  the  latter  nation  has  long  led  the  world  in  its 
low  typhoid  rate.^  America's  bad  showing  was  proba- 
bly dependent  on  several  factors,  prominent  among  them 
being  (1)  our  very  widely  scattered  population,  (2)  the 
great  extension  of  typhoid  to  all  parts  of  the  country  by 
soldiei's  of  the  Civil  War,  (3)  poorer  and  less  enlight- 
ened medical  and  public  health  service  than  in  Ger- 
many, (4)  ignorance  and  indifference  on  the  part  of  the 
public.  The  first  of  these  factors  still  obtains,  though 
modified  by  improved  facilities  for  transportation,  the 
influence  of  the  second  is  beginning  to  yield  to  opposi- 
tion, the  third  is  being  corrected  as  rapidly  as  may  be 
expected,  and  that  the  fourth  follows  the  third  is  shown 
by  the  generous  support  now  given  by  the  public  to 
many  movements  for  the  improvement  of  health,  by  the 
prominence  given  such  subjects  by  the  papers  and  mag- 
azines, and  by  the  fact  that  many  line  officers  do  know 
and  all  have  it  in  their  power  to  know  more  concerning 
the  methods  of  spread  and  the  means  of  prevention  of 
typhoid  than  did  the  medical  officers  of  1898. 

Methods  of  Transmission 

Investigators  generally  now  regard  sick  and  healthy 
carriers  to  be  the  source  of  typhoid,  while  some  of  the 
^       .  most  eminent  of  them  regard  endemic  ty- 

phoid,  that  is,  typhoid  always  present  in  a 
place,  as  nearly  always  due  to  healthy,  chronic  carriers. 
A  carrier  of  typhoid  is  a  person  who  passes  the  living 

^  Professor  Max  Rubner,  Director  of  the  Hygienic  Institute,  Uni- 
versity of  Berlin,  said  in  1913,  "  As  a  young  man  I  saw  the  mighty 
typhoid  fever  epidemics  in  our  country,  especially  in  Munich,  my  na- 
tive town,  which  formerly  decimated  the  population  :  to-day  typhoid 
fever  has  diminished,  as  I  have  been  told  by  a  clinical  friend,  until 
there  is  not  sufficient  typhoid  fever  for  the  clinical  lectures." 


ALIMENTARY  TRACT  INFECTION  229 

and  virulent  bacilli  from  his  body,  usually  in  his  feces 
or  urine,  in  such  a  condition  that  they  may  infect  other 
persons.  The  carrier  may  be  just  entering  on  the  disease, 
may  be  very  sick  with  it,  or  may  be  in  good  health.  In 
the  last  named  instance  he  may  have  had  the  disease 
and  recovered  from  it,  or  he  may  be  merely  a  "  contact 
carrier,"  a  person  who  has  obtained  the  germs  from  an- 
other case  and  in  whom  they  multiply,  but  one  who  has 
never  been  sick  with  the  disease.  Ordinarily  the  term 
"  carrier  "  is  used  as  meaning  a  chronic  carrier  and  well 
person,  but  a  person  in  the  early  stages  of  the  disease, 
who  continues  at  his  work,  is  quite  as  dangerous,  and 
some  of  the  most  serious  typhoid  epidemics  of  recent 
years  have  been  due  to  carriers  of  this  type.  This  in- 
cludes the  cases  of  "  walking  typhoid."  As  tending  to 
show  how  commonly  infected  persons  continue  at  their 
work,  the  following  conclusions  of  the  Reed  Board  may 
be  quoted  :  "  (43.)  In  addition  to  the  recognized  cases 
of  typhoid  fever,  there  were  many  short  or  abortive  at- 
tacks of  this  disease  which  were  generally  diagnosed  as 
some  forms  of  malarial  fever."  "  (46.)  Army  surgeons 
correctly  diagnosed  about  half  the  cases  of  typhoid 
fever."  Since  that  time  the  methods  of  diagnosis  have 
so  greatly  improved  that  the  disease  can  be  detected 
with  much  more  certainty  and  touch  earlier,  with  result- 
ing improvement  in  its  control,  but  even  yet  early  cases 
are  a  source  of  great  danger,  for  the  reason  that  diag- 
nosis is  not  always  sought  early  by  the  patient,  who  is 
apt  to  think  that  he  has  only  a  bit  of  indigestion  or  a 
cold.  An  examination  of  the  blood  of  every  patient 
showing  any  sort  of  febrile  intestinal  disturbance  at  Val 
de  Grace  in  1907,  '08,  and  '09  showed  typhoid  bacilli  in 
forty  per  cent  of  them,  though  in  many  there  were  no 


230       THE  PREVENTION  OF  EPIDEMICS 

other  symptoms  suggesting  typhoid.  The  actually  bed- 
fast  patient  is  less  apt  to  spread  the  disease  widely  be- 
cause of  the  limitation  of  his  activities.  Except  that  his 
dejecta  may  be  disposed  of  so  carelessly  as  to  infect  water 
supplies,  he  is  mainly  dangerous  to  his  attendants. 

The  chronic  carrier,  however,  is  a  menace  to  nearly 
all  with  whom  he  deals  or  comes  in  contact,  because 
neither  be  nor  they  suspect  that  he  is  a  source  of 
danger.  Since  the  investigation  of  the  first  recog- 
nized chronic  carrier,  many  interesting  cases  have  been 
studied  and  their  histories  worked  out,  and,  as  they 
illustrate  the  dangers  from  this  source,  a  few  of  them 
will  be  detailed.  The  first  case  reported  was  that  of  the 
female  proprietor  of  a  bakery  in  Strassburg.  All  of  her 
employees  would  sooner  or  later  get  typhoid,  and  the 
cause  could  not  be  located.  It  was  at  length  ascertained 
that  the  woman,  who  had  had  typhoid  ten  years  pre- 
viously, was  still  passing  very  large  numbers  of  typhoid 
bacilli  in  her  stools.  In  a  British  reformatory  there  had 
been  intermittent  outbreaks  of  typhoid,  three,  four,  or 
five  cases  occurring  at  a  time.  Inquiry  pointed  to  milk 
as  the  cause,  but  inspection  of  the  dairy  and  its  sur- 
roundings showed  good  sanitary  conditions.  Neverthe- 
less the  disease  continued  to  appear.  Search  among 
those  handling  the  milk  in  the  institution  led  to  the 
examination  of  a  girl  who  had  had  typhoid  six  years 
previously.  Two  examinations  of  her  stools  were  nega- 
tive, but  the  third  showed  that  she  was  passing  typhoid 
bacilli.  Her  removal  from  the  kitchen  ended  the  epi- 
demics. 

The  first  instance  thoroughly  worked  up  in  America 
was  a  very  instructive  one.  The  investigation  began 
with  the  efforts  to  trace  a  small  epidemic,  six  persons 


ALIMENTARY  TRACT  INFECTION  231 

in  a  household  of  eleven  being  attacked  with  the  disease. 
Thorough  investigation  at  the  time  of  this  outbreak  and 
for  some  time  subsequently  failed  to  disclose  the  source 
of  infection  in  the  food,  drink,  or  general  sanitary  con- 
ditions. At  length  suspicion  was  directed  to  a  cook  who 
had  worked  in  the  house  for  a  few  weeks,  beginning 
about  three  weeks  before  the  appearance  of  the  disease. 
With  great  difficulty  Dr.  George  A.  Soper  was  able  to 
trace  part  of  her  history  during  a  period  of  ten  years, 
in  which  she  was  known  to  have  lived  in  eight  families 
where  inquiries  could  be  made.  In  seven  of  these  she 
had  been  associated  with  typhoid  outbreaks,  always 
escaping  the  disease  herself.  In  the  seven  families  there 
were  twenty-six  cases  of  typhoid,  with  one  death.  Owing 
to  the  cook's  refusal  to  tell  anything  about  herself,  and 
the  fragmentary  character  of  the  history  obtained,  it  is 
probable  that  she  had  been  associated  with  other  cases. 
On  the  information  obtained,  however,  the  New  York 
Department  of  Health  caused  her  removal  to  the  Deten- 
tion Hospital,  where  she  was  examined,  in  spite  of  her 
objections  and  resistance,  and  was  found  to  be  passing 
great  numbers  of  typhoid  germs  in  her  feces. 

Another  striking  case  is  reported  from  Prussia,  where 
typhoid  had  been  epidemic  on  a  large  estate  for  four- 
teen years.  During  that  time  there  had  been  thirty-two 
cases  of  the  disease  among  one  hundred  and  eighty 
persons  on  the  estate.  Investigations  focused  attention 
on  the  dairy,  all  of  the  persons  involved  having  used 
milk  from  it.  A  woman  employed  there  had  had  typhoid 
seventeen  years  before,  and  the  bacteria  were  found  in 
her  stools  almost  to  the  exclusion  of  other  varieties. 
She  had  worked  in  the  dairy  fourteen  years,  and  had 
been  spreading  the  disease  during  that  time.  Instances 


232       THE  PREVENTION  OF  EPIDEMICS 

of  epidemics  caused  by  chronic  carriers  have  been  very 
numerous  and  such  carriers  are  well  recognized  as  one 
of  the  more  common  causes  of  epidemics.  Usually  the 
epidemic  is  due  to  the  fact  that  the  carrier  deals  in  or 
handles  food  for  other  persons.  That  such  is  not  always 
the  case,  however,  is  shown  by  such  instances  as  the 
following:  A  nursing  mother  had  typhoid  and  her  in- 
fant was  taken  to  a  friend's  house.  The  child  had  a 
slight  diarrhoea  but  was  being  weaned,  and  no  particu- 
lar attention  was  paid  to  this  until,  one  after  another, 
six  members  of  the  friend's  family  developed  tj-^phoid. 
Examination  of  the  child's  blood  then  showed  that  it 
had  typhoid. 

The  case  of  a  sailor  investigated  in  San  Francisco  is 
of  striking  interest.  In  three  years  and  seven  months 
there  were  26  cases  of  typhoid  on  a  ship  whose  crew  num- 
bered 21  men,  and  this  sailor,  who  had  had  typhoid 
four  years  before,  was  found  to  be  a  carrier  and  almost 
certainly  responsible,  though  he  did  not  handle  foods 
as  cook  or  kitchen  helper.  The  close  and  intimate  con- 
tact of  life  on  a  small  vessel  gave  him  the  opportunity 
to  spread  the  infection.  A  case  known  to  the  writer  has 
suggested  the  thought  that  a  prostitute  who  happened 
to  be  also  a  chronic  carrier  might  scatter  the  disease 
by  plying  her  trade.  Conversely,  as  the  infection  in 
male  carriers  is  at  times  localized  in  the  seminal  ves- 
icles, it  is  possible  that  such  a  one  might  infect  the 
female  having  intercourse  with  him. 

Still,  as  said  before,  the  danger  usually  comes  through 
contamination  of  food,  and  the  very  great  importance 
of  cleanliness  on  the  part  of  cooks  and  other  persons 
handling  foods,  and  the  necessity  of  investigating  the 
kitchen  in  the  case  of  company  outbreaks,  should  al- 


ALIMENTARY   TRACT  INFECTION  233 

ways  be  borne  in  mind.  A  severe  company  outbreak  at 
Fort  D.  A.  Russell  in  1909  was  found  to  be  due  to 
contamination  of  food  by  men  working  on  kitchen  police 
while  in  the  early  stages  of  the  disease. 

About  five  per  cent  of  typhoid  cases  are  carriers  after 
their  recovery.  They  may  remain  such  for  months  or 
for  years.  Epidemics  have  been  traced  to  persons  who 
were  carriers  after  attacks  occurring  more  than  fifty 
years  previously,  and  more  than  one  instance  of  "  family 
predisposition  "  to  typhoid  has  been  traced  to  a  family 
grandmother  who  had  been  distributing  the  infection 
with  food  prepared  for  the  rising  generations. 

As  already  stated,  healthy  carriers  of  cholera  are 
well  recognized,  and  epidemics  have  been  traced  directly 
to  them.  So  far  as  is  known,  however,  they  do  not  re- 
main carriers  for  many  years  as  do  typhoid  carriers, 
eight  weeks  being  a  long  period.  The  belief  that  this 
is  true  is  strengthened  by  the  history  of  cholera  in  Italy 
in  1911  and  1912.  In  the  former  year  it  caused  7000 
deaths,  but  it  died  out  in  the  winter  and  did  not  re- 
appear in  1912.  This  would  scarcely  have  been  possible 
with  so  extensive  an  outbreak  of  typhoid.  Dysentery 
carriers  are  also  numerous  in  some  countries,  and  some 
of  them  remain  carriers  for  many  years.  They  are  com- 
mon in  the  Philippines. 

The  effort  is  always  made  in  our  military  practice,  and 
in  the  better  class  of  civil  institutions,  not  to  discharge 
typhoid  or  cholera  patients  from  hospital  until  repeated 
examinations  of  stools  and  urine  have  shown  that  they 
no  longer  excrete  the  causative  bacilli. 

Water  was  not  found  by  the  Reed  Board  to  be  an 
important  factor  in  the  spread  of  typhoid 
in  the  national  encampments  in  1898;  but 


234       THE  PREVENTION  OF  EPIDEMICS 

it  has  so  often  been  demonstrated  as  the  most  impor- 
taut  factor  in  other  epidemics,  that  all  authorities 
agree  in  considering  it  one  of  the  first  subjects  to  be 
investigated  in  case  of  any  outbreak.  This  method  of 
transmission  is  so  well  recognized  and  so  generally 
known  that  it  is  not  necessary  to  cite  any  of  the  very 
numerous  instances  showing  it.  Prior  to  1898  practi- 
cally all  of  the  great  epidemics  that  had  been  studied 
wei'e  traced  to  infected  drinking-supplies,  and  the  dis- 
ease was  regarded  as  mainly,  if  not  entirely,  water- 
borne.  This  fact  helps  to  account  for  the  size  and  extent 
of  the  great  camp  epidemics  of  that  year.  Cholera  and 
dysentery  have  also  usually  been  traced  to  infected 
water.  There  is,  however,  the  possibility  that  both  may 
be  transmitted  in  the  other  ways  to  be  considered. 

The  germs  may  be  ingested  directly  in  polluted  drink- 
ing water,  and  such  is  the  usual  method  in  large  epi- 
demics due  to  water.  The  danger  in  such  instances  of 
course  increases  with  the  dose  of  germs,  that  is,  with 
increase  in  the  degree  of  pollution  or  in  the  length  of 
time  the  water  is  used.  It  may  also  occur  in  less  obvious 
ways.  Thus,  water  that  is  used  in  clothes-washing  or 
bathing  may  become  infected  from  the  clothing  or  per- 
sons of  sick  men  or  carriers,  and  may  later  infect  the 
hands  or  persons  of  the  people  handling  or  using  it,  or 
the  vessels  in  which  it  was  contained.  Or  men  may  con- 
tract the  disease  by  bathing  or  swimming  in  infected 
streams  or  pools,  and  inadvertently  taking  water  into 
their  mouths,  noses,  or,  possibly,  their  eyes. 

The  influence  of  water  in  spreading  typhoid  is  well 
shown  by  the  drop  in  typhoid  deaths  in  cities  putting 
in  new  and  good  water  supplies.  The  statistics  of 
deaths  in  6fty  such  cities  showed,  upon  examination  in 


ALIMENTARY  TRACT  INFECTION  235 

1913,  very  great  improvement,  the  most  striking  in- 
stance of  it  being  in  Pittsburg,  where  the  typhoid  deaths 
per  100,000  of  population  fell  from  74.3  to  12.7,  and  in 
the  districts  getting  the  good  water  to  6.9. 

The  U.  S.  Public  Health  Report  for  August  7, 1914, 
contains  an  article  on  "Safe  Ice"  which  concludes 
with  the  following  summary:  — 

"  1.  Clear  ice  is,  of  itself,  as  free  from 
the  danger  of  conveying  infectious  diseases  as  we  need 
wish. 

"  2.  Dirty  or  cloudy  ice  may  be  dangerous.  It  should 
not  be  placed  in  water  nor  on  food  which  is  to  be  eaten 
uncooked. 

"  3.  There  may  be  danger  in  eating  iced  foods  or 
using  iced  drinks  if  the  ice  is  improperly  handled  when 
placed  in  contact  with  the  food  or  drink. 

"  4.  We  may  eliminate  all  danger  by  avoiding  the 
handling  of  ice  with  dirty  hands,  by  washing  the  ice 
with  pure  water,  and  by  using  only  clear  ice. 

"  6.  The  average  laboring  person  does  not  always 
have  the  opportunity,  even  if  he  have  the  inclination, 
to  cleanse  his  hands  after  attending  to  those  necessities 
of  nature  which  require  their  use  for  purposes  which 
almost  invariably  result  in  their  contact  with  excreta 
which  may  contain  the  organisms  of  disease,  even  in 
apparently  healthy  people. 

*'  It  is  therefore  impossible  to  overestimate  the  dan- 
ger resulting  from  the  handling  of  ice  by  unknown  per- 
sons if  the  ice  is  placed  in  direct  contact  with  drinking 
water.  Consequently  in  hotels,  cars,  stations,  and  simi- 
lar places  where  intelligent  personal  supervision  is  im- 
possible or  impracticable,  those  furnishing  the  water 
should  be  instructed,  and  indeed  compelled  by  law,  to 


236       THE   PREVENTION   OF  EPIDEMICS 

adopt  such  means  of  cooling  water  as  do  not  require 
direct  contact  of  ice  and  water." 

Milk-borne  epidemics  of  typhoid  are  also  well  recog- 
nized, and  many  of  them  have  been  thoroughly  studied. 
The  milk  is,  in  the  great  majority  of  in- 
stances, contaminated  from  the  hands  of 
milkers,  dealers,  or  other  handlers  who  are  suffering 
from  beginning  typhoid  and  have  not  yet  ceased  work, 
who  are  convalescing  from  the  same  disease,  or  who 
have  had  it  formerly  and  are  still  "  carriers,"  The  con- 
tamination may  occur  in  other  ways,  such  as  the  use  of 
infected  water  for  washing  cans  or  diluting  milk.  It 
may  also  linger  long  in  cans  once  infected,  if  they  are 
not  properly  washed  and  sterilized,  as  the  germs  will 
multiply  in  milk.  As  the  same  thing  is  true  of  the 
germs  of  cholera  and  dysentery,  they  may  also  be  milk- 
borne. 

One  of  the  largest  milk-borne  epidemics  of  typhoid 
fever  occurred  in  the  suburbs  of  Boston  in  the  spring 
of  1908.  Four  hundred  and  ten  cases  occurred,  the  in- 
fection being  traced  to  a  milk-dealer  who  continued  his 
work  for  two  weeks  after  the  onset  of  the  typhoid  fever 
from  which  he  later  died. 

An  epidemic  of  295  cases  at  Worcester,  Massachu- 
setts, in  1911,  was  traced  to  milk  infected  by  a  carrier 
who  had  had  typhoid  twenty-six  years  previously.  That 
both  of  these  epidemics  are  reported  from  the  same 
state  is  an  indication  of  the  thorough  investigations 
and  reports  made  in  that  state,  and  not  to  any  greater 
prevalence  of  typhoid  there  than  in  other  states. 

Lettuce,  radishes,  and  other  vegetables  or  fruits  that 
are  eaten  uncooked  may  be  contaminated  by  unclean 
handling,  by  washing  in  polluted  water,  by  contact  with 


ALIMENTARY  TRACT  INFECTION  237 

typhoid  feces  or  urine  in  manure,  by  flies,  or  by  in- 
fected dust  blown  and  deposited  on  them. 
Bread,  cool  meats,  and  other  food-articles     ,  ,  ", 

may  also  be  contaminated  in  some  of  these 
ways  after  they  are  cooked.  Any  article  so 
polluted  might  cause  the  disease  if  it  were 
eaten. 

An  interesting  typhoid  outbreak  in  the  German  army, 
reported  in  1909,  was  traced  to  a  woman  carrier  who 
prepared  vegetables  in  a  maneuver  camp.  The  very 
careful  investigation  made  indicated  that  124  men 
were  probably  infected,  though  only  27  of  them  were 
sick  enough  to  be  classed  clinically  as  typhoid.  Yet 
any  or  all  of  them  might  have  been  sources  of  danger 
to  the  commands  to  which  they  belonged. 

The  avoidance  of  uncooked  fruit  and  vegetables 
from  and  in  places  where  cholera  prevails  is  a  matter 
of  great  importance. 

Many  epidemics  of  typhoid  fever  have  been  traced  to 
the  consumption  of  oysters  and  other  shellfish  gathered 
from  sewerage-infected  beds.  For  twenty- 
five  years  the  city  of  Belfast  had  had  the  ® 

greatest  mortality  from  typhoid  of  all  the  cities  in  the 
United  Kingdom,  in  spite  of  a  good  water-supply  and 
good  general  sanitation.  A  commission  appointed  in 
1907  to  investigate  the  matter  showed  that  the  endemic 
prevalence  of  the  disease  was  due  to  the  unrestricted 
gathering  of  cockles,  mussels,  and  other  shellfish  from 
the  "  slob-lands  "  of  Belfast  Lough,  which  are  laden 
with  the  city's  sewage.  Hundreds  of  acres  are  exposed 
at  low  tide,  and  the  shellfish  are  gathered  by  the  poorer 
classes,  who  generally  eat  them  raw.  The  Jews,  who  do 
not  eat  them,  were  exempt  from  the  disease.  It  is  prob- 


238       THE  PREVENTION  OF  EPIDEMICS 

able  that  cholera  and  dysentery  may  be  transmitted  in 
the  same  way. 

Living  and  virulent  typhoid  organisms  have  been 
found  in  the  mouths  of  persons  sick  with  the  disease, 
and  the  vomit  of  cholera  may  contain  the 
germs  of  that  ailment.  It  may  therefore  be 
understood  that  the  common  use  of  drink- 
*^  ing-cups,  clinical  thermometers,  and  other 

articles  that  are  put  to  the  mouth,  may  lead  to  infection. 
In  all  of  the  diseases  discussed  in  this  chapter  the  or- 
ganisms occur  in  the  intestines,  and  careless  use  of 
rectal  syringes  may  spread  them.  Such  an  accident  is, 
of  course,  more  apt  to  occur  in  hospitals. 

None  of  these  diseases  is  air-borne  in  the  sense  that 
smallpox  and  scarlet  fever  are,  but  feces,  urine,  or 
other  material  containing  the  causative  or- 
ganisms may  be  scattered  as  dust  when  well 
or  partially  dried  and  pulverized,  and  may  be  inhaled 
in  that  form,  or  may  light  on  articles  of  food  or  drink 
and  be  ingested  with  them.  The  Reed  Board  reported : 
"  (31.)  It  is  probable  that  the  infection  was  disseminated 
to  some  extent  through  the  air  in  the  form  of  dust." 

"  (28.)  Flies  undoubtedly  served  as  carriers  of  the 
infection.  Flies  swarmed  over  infected  fecal  matter  in 
the  pits,  and  then  visited  and  fed  upon  food  prepared 
for  the  soldiers  at  the  mess  tents.  In  some  instances 
Flies  where  lime  had  recently  been  sprinkled  over 

J  the  contents  of  the  pits,  flies  with  their  feet 

other  whitened  with  lime  were  seen  walking  over 

Vermin       *^^  food.   It  is  possible  for  the  fly  to  carry 
the  typhoid  bacillus  in  two  ways.    In  the 
first  place,  fecal  matter  containing  the  typhoid  germ 
may  adhere  to  the  fly  and  be  mechanically  transported. 


ALIMENTARY  TRACT  INFECTION  239 

In  the  second  place,  it  is  possible  that  the  typhoid 
bacillus  may  be  carried  in  the  digestive  organs  of  the 
fly  and  be  deposited  with  its  excrement." 

Several  asylum  epidemics  of  dysentery,  notably  one 
at  the  Dan  vers  State  Hospital  (Mass.),  have  been  shown 
to  be  spread  by  flies,  and  the  large  annual  epidemics  in 
Fiji  from  December  to  March  have  been  ascribed  to 
the  same  agency.  Flies  caught  during  an  Indian  epi- 
demic of  cholera  in  1912  were  found  to  have  cholera 
vibrios  both  on  their  external  appendages  and  in  their 
intestinal  canals. 

Recent  work  in  the  Philippine  Bureau  of  Science 
has  shown  that  cockroaches  fed  on  human  cholera  feces 
may  harbor  cholera  vibrios  in  their  intestines,  and  these 
may  appear  in  enormous  numbers  in  the  insect's  feces 
for  at  least  two  days  after  the  feeding,  and  in  smaller 
numbers  for  a  longer  time,  and  if  deposited  on  human 
food  with  the  cockroach  feces  they  may  there  survive 
for  another  four  days.  By  means  of  either  feces  or 
vomit  from  cholera  cases  the  cockroach  may  carry  in- 
fection to  human  food.  The  same  investigation  showed 
that  cholera  vibrios  may  be  found  in  the  bodies  of  ants 
for  eight  hours  after  they  have  ingested  feces  from 
cholera  patients.  There  is  little  room  for  doubt  that 
both  of  these  insects  could  carry  typhoid,  probably 
more  readily  than  cholera. 

It  would  be  well  for  the  line  officer  to  know  the 
following  facts  concerning  house-flies.  They  breed  in 
horse-manure,  human  feces,  and  other  filth,  and  can 
readily  emerge  through  six  inches  of  loose  earth,  but 
not  through  earth  saturated  with  water.  When  breed- 
ing in  feces,  the  larvae  will  go  into  the  earth  five  or  six 
inches  as  the  feces  dries,  and  there  find  more  congenial 


240       THE  PREVENTION   OF  EPIDEMICS 

surroundings.  Flies  are  naturally  most  numerous  about 
manure  piles,  trench  latrines,  and  kitchens,  because  they 
find  in  those  places  the  best  breeding  and  feeding 
places  respectively.  The  female  lays  about  120  eggs, 
and  the  development  of  these  varies  with  the  tempera- 
ture, in  the  tropics  somewhat  as  follows :  — 

Hot  Weathkk    Cold  Wkathbb 
Days  Days 

Eggs  hatch  in  12 

Maggots  change  to  pupse  in  5  14 

Pupse  change  to  adult  flies  in       3  5 

Total  Short       9        long  21  or  more 

In  temperate  and  cold  climates  all  the  stages  of  the 
fly's  life  may  be  prolonged,  so  that  the  full  change  from 
adult  to  adult  may  require  as  much  as  two  months, 
while  adults  and  possibly  pupae  last  through  the  win- 
ter and  start  the  cycle  again  in  the  spring.  The  fly  does 
not  pupate  in  a  wet  medium  if  the  full-grown  larvae 
can  find  means  of  migrating  to  a  dry  place  protected 
from  the  sun;  for  example,  at  the  edge  of  the  manure 
pile,  under  boards,  or  in  cracks.  Here  the  pupal  cases 
may  be  found  as  small,  brown  shells  the  size  of  plump 
grains  of  wheat,  and  in  great  numbers.  It  has  been 
found  that  bacteria  such  as  those  causing  typhoid  sur- 
vive much  longer  in  than  on  flies,  and  longer  in  the  in- 
sect's gut  than  in  its  deposited  feces.  A  study  of  the 
flies  of  New  York  City  in  1911  brought  out  the  follow- 
ing facts  that  are  of  interest  as  bearing  on  the  seasonal 
occurrence  of  typhoid  and  summer  diarrhoea  (bacillary 
dysentery).  Up  to  the  end  of  June  the  flies  were  found 
to  be  practically  free  from  fecal  bacteria.  During  July 


ALIMENTARY  TRACT  INFECTION  241 

and  August  the  flies  examined  carried  millions  of  bac- 
teria, whereas  at  other  seasons  they  carried  hundreds 
only.  Fecal  bacteria  of  the  colon  bacillus  type  were 
first  found  abundant  in  July.  The  bacteria  were  8.6 
times  as  numerous  in  the  intestines  as  on  the  surface 
of  the  flies.  Extensive  experiments  and  observations 
in  Cambridge,  England,  indicate  that  houseflies  tend  to 
travel  against  or  across  the  wind,  apparently  attracted 
by  odors.  The  chief  conditions  favoring  dispersal  of 
flies  are  fine  weather  and  warm  temperature.  They  do 
not  travel  as  far  in  towns  as  in  the  country,  the  maxi- 
mum flight  observed  in  thickly  populated  parts  of 
Cambridge  being  a  fourth  of  a  mile,  while  in  the  open 
country  single  fliglits  may  double  that. 

Contact  with  sick  persons  offers  many  opportunities 
for  both  mediate  and  immediate  infection,  and  the  class 
of  diseases  under  discussion  often  infect  r*  t  i- 
nurses  and  attendants.  The  typhoid  patient, 
as  stated  before,  may  give  off  the  germs  of  the  disease 
from  his  bowels,  bladder,  or,  occasionally,  his  mouth. 
From  these  sources  the  bacilli  get  on  towels,  bedding, 
urinals,  chamber  pots,  the  patient's  skin,  and  into  bath 
water.  Any  of  these  articles  may  be  handled  by  nurses, 
associates,  or  casual  visitors,  who  may  thereby  infect 
their  own  hands  or  persons,  and  later  take  the  germs 
into  the  mouth.  Persons  using  the  same  drinking  glasses, 
linen,  or  other  personal  articles,  as  the  sick  man,  are 
especially  apt  to  be  infected.  This  method  of  infection 
is  now  regarded  as  very  important.  The  greatest  care 
in  cleanliness  and  disinfection  is  necessary  on  the  part 
of  all  hospital  attendants  and  others  brought  in  contact 
with  the  disease.  The  danger  is  of  course  greater  if  the 
nature  of  the  disease  is  unknown,  and  the  subject  pur- 


242       THE  PREVENTION   OF  EPIDEMICS 

sues  his  ordinary  course  of  life,  eating,  drinking,  sleep 
ing,  defecating,  and  urinating,  with  no  thought  of  being 
a  menace  to  others. 

Tent-mates  and  bed-mates,  and  members  of  the  same 
family  and  household,  are  particularly  exposed.  The 
Reed  Board  published  the  following  conclusions  that 
bear  on  the  subject:  "  (30.)  Typhoid  fever,  as  it  devel- 
oped in  the  regimental  organizations,  was  characterized 
by  a  series  of  company  epidemics,  each  one  having  more 
or  less  perfectly  its  own  individual  characteristics.  .  .  . 
Of  1608  cases  of  typhoid  fever  which  we  have  been 
able  to  accurately  locate  in  the  particular  tents  in  which 
they  occurred,  together  with  the  date  of  the  commence- 
ment of  the  attack,  the  results  may  be  summarized  as 
follows :  — 

"  Directly  connectable  attacks,  563,  or  35.01  per 
cent. 

"  Indirectly  connectable  attacks,  447,  or  27.79  per 
cent. 

"Total  connectable  attacks,  1010,  or  62.8  per  cent. 

.  .  .  "We  believe,  therefore,  that  personal  contact 
was  a  very  important  factor,  probably  the  most  im- 
portant, in  the  spread  of  the  disease." 

The  Germans,  after  years  of  careful  and  most  valu- 
able work  by  a  government  commission  on  typhoid  in 
southwest  Germany,  regard  contact  as  the  main  method 
of  spread  of  the  disease.  The  contact  is  with  the  sick, 
the  sickening  or  the  healthy  carrier,  but  usually  with 
one  just  sickening.  The  German  commission  found 
typhoid  bacilli  in  the  blood  of  an  apparently  healthy 
boy  of  twelve,  whose  sister,  in  the  same  house,  had  the 
disease.  Four  days  later  the  boy  sickened.  He  was  a 
source  of  danger  even  before  he  appeared  sick.  Exam- 


ALIMENTARY  TRACT  INFECTION        243 

ination  of  600  cases  of  typhoid  in  the  Saar  district 
showed  that  a  large  proportion  of  contact  infections 
must  have  occurred  during  or  before  the  first  week  of 
sickness  of  the  infecting  cases,  even  assuming  the  in- 
cubation period  to  be  so  short  as  ten  days.  In  fact,  more 
than  half  of  the  contact  cases  seemed  to  have  been  in- 
fected thus. 

Contact  infection  was  the  main  cause  of  the  spread 
of  cholera  in  the  Bulgarian  army  in  1913.  Recruits 
neglected  to  use  latrines,  soiled  the  ground,  and  later 
infected  their  hands  in  removing  shoes  and  clothing. 

It  will  be  readily  understood  that  the  dangers  of 
contact  would  be  greatly  increased  by  crowding,  poor 
ventilation,  and  uncleanly  habits. 

House  epidemics  of  cholera  are  common  in  the  Philip- 
pines during  epidemic  seasons,  and  owe  their  origin  and 
spread  to  the  causes  discussed  above,  to  the  common 
use  of  food  and  drinking  utensils,  and  to  infection  con- 
tracted in  cleaning  up  vomit  and  watery  stools.  There 
is  good  reason  to  think  that  dysentery  and  diarrhoea 
may  be  spread  in  the  same  ways,  while  it  is  well  known 
that  intestinal  worms  often  are,  among  children. 

The  above  discussion  of  the  dangers  of  contact  with 
sick  persons  may  be  applied  equally  well  to  similar  re- 
lations with  carriers,  except  that  they  are  not  known 
to  their  associates  to  be  sources  of  danger,  and  are 
thereby  rendered  mpre  harmful.  They  are  more  apt 
than  sick  men  to  sleep  with  other  persons,  to  lend  or 
borrow  clothing,  to  be  put  on  duty  in  kitchens,  or  han- 
dling foods,  or  caring  for  cows,  while  no  precautions  are 
taken  in  the  matters  of  disinfecting  their  clothing, 
stools,  or  urine. 

It  does  not  require  lengthy  argument  to  demonstrate 


244       THE  PREVENTION  OF  EPIDEMICS 

that,  if  urine  and  feces  contain  disease-producing  germs 

and  are  deposited  on  the  surface  of  the  ground  about 

_    .,    ,  camps  or   are    allowed  to    soil  the   edges 

Soiled  ,    .  .  .       f ,      .  ,    . 

and  vicinity  of  latrines,  men  may  get  their 

shoes  soiled  with  such  matters  and  the  con- 
tained germs.  Such  being  the  case,  the  contamination 
might  easily  be  conveyed  to  tents,  bunks,  company 
streets,  and  the  hands  of  the  men.  Needless  to  say,  such 
infection  could  be  conveyed  even  though  all  gross  evi- 
dence of  fecal  or  urinary  soiling  were  removed. 

The  term  fomites  includes  such  inanimate  articles  or 
substances  as  are  thought  capable  of  absorbing,  preserv- 
_,       .  ing,  and  transmitting  tlie  contagion  of  dis- 

ease, and  is  used  as  a  general  designation 
for  such  things  as  books,  clothing,  tents,  bedding,  and 
baggage.  Clothing  that  is  grossly  contaminated,  such  as 
sheets  or  shirts  soiled  by  the  diarrhoeal  discharges  of 
sick  men,  is,  of  course,  most  dangerous,  but  the  danger 
in  such  cases  is  apt  to  be  recognized  and  provision  made 
for  it.  On  the  other  hand,  bedding  soiled  by  dirty 
shoes,  tents  that  have  been  urinated  upon,  the  clothing 
of  apparently  well  carriers,  and  other  articles  may  be 
infected  and  show  no  signs  of  it,  and  so  do  great  harm. 

Laundry-workers,  hospital  attendants,  and  tent-mates 
of  the  sick  are  naturally  more  liable  than  others  to 
infection  in  this  way;  yet  all  may  be  exposed  to  it  in 
time  of  epidemics. 

Prevention  and  Control 

The  general  measures  for  the  prevention  of  these 

diseases  are  those  hygienic  precautions  that  have  been 

discussed  in  preceding  chapters.  If  cases  do  begin  to 

appear  in  a  command,  it  is  evident  that  they  have  not 


ALIMENTARY  TRACT  INFECTION        245 

been  sufficient,  and  more  vigorous  steps  should  be  taken 
to  protect  the  men  not  yet  infected.  If  they  show  in 
the  neighborhood  of  the  command,  or  along  lines  of 
communication  with  it,  the  same  active  measures  should 
be  adopted.  The  best  prospects  for  the  prevention  or 
control  of  the  epidemic  will  be  offered  if  the  following 
steps  be  taken. 

One  of  the  most  important  of  these  is  early  diagnosis 
of  the  dangerous  cases.    As  long  as  their  nature  is  un- 
known, they  continue   to  disseminate  the  —     , 
disease-germs ;   and  such  undiagnosed  or  _. 
wrongly  diagnosed   cases    apparently  had 
much  to  do  with  the  spread  of  typhoid  fever  in  the 
camps  in  1898.  At  that  time  the  methods  of  diagnosis 
were  not  so  good  as  at  present,  and  a  positive  diagnosis 
of  typhoid  could  not  usually  be  made  until  after  the 
patient  had  been  sick  a  week  or  more.   Laboratory 
methods  now  permit  of  it  sooner,  but  they  are  not 
always  available,  and  the  safe  rule  is  to  regard  and 
handle  suspected  cases  as  though  the  disease  were  known 
to  be  typhoid. 

The  diagnosis  is  a  matter  for  the  medical  officer  to 
worry  over,  but  the  line  officer  can  be  of  assistance  if 
he  instructs  his  men  to  go  on  sick  report  if  they  are  not 
well,  and  if  he  does  not  unduly  encourage  the  notion 
that  men  only  seek  sick  report  to  escape  work.  It  is 
at  any  rate  better  that  two  or  three  frauds  should  be 
allowed  to  loaf  for  a  time  than  that  one  sick  man  should 
be  allowed  to  spread  disease  through  the  command. 
The  Reed  Board  made  the  following  findings  that  bear 
on  the  difficulties  and  importance  of  early  diagnosis :  — 

"  (46.)  Army  surgeons  correctly  diagnosed  about  half 
the  cases  of  typhoid  fever." 


246       THE  PREVENTION  OF  EPIDEMICS 

"  (14.)  A  man  infected  with  typhoid  fever  may  scat- 
ter the  infection  in  every  latrine  in  a  regiment  before 
the  disease  is  recognized  in  himself." 

Diagnosis  is  of  no  value  in  the  prevention  of  epi- 
demics unless  it  leads  to  immediate  steps  to  prevent 
T  lat'nn  i^^^ction  through  contact,  soil  -  pollution, 
water -pollution,  and  in  other  ways.  It 
should  therefore  lead  to  the  isolation  of  all  recognized 
or  suspected  cases,  and  such  measures  of  care  as  will 
prevent  their  spreading  the  disease  in  any  of  the  ways 
discussed  in  this  chapter.  Such  measures  must  include 
screening  from  flies,  disinfection  of  clothing  and  linen, 
of  bath  water,  dishes  and  utensils,  of  stools,  urine,  and 
spit.  Only  the  necessary  attendants,  and  they  well- 
trained  ones,  should  have  access  to  the  patients.  The 
isolation  should  at  times  include  suspects  who  have 
been  exposed  to  disease  as  well  as  the  actually  sick. 
This  is  particularly  true  as  regards  cholera.  It  is  neces- 
sary in  a  less  degree  for  typhoid,  and  still  less  for  dys- 
entery. Whenever  resorted  to,  such  isolation  should 
more  than  cover  the  ordinary  period  of  incubation  of 
the  disease.  Cholera  suspects  should  be  isolated  for  five 
days,  those  suspected  of  typhoid  for  three  weeks  or  un- 
til well  and  free  from  bacilli.  In  the  latter  disease  such 
strict  isolation  may  not  be  necessary,  but  in  case  of  se- 
vere epidemics  it  will  be  wise,  and  can  be  done  in  iso- 
lation camps,  where  the  men  can  work,  drill,  and  play. 
At  times  it  may  be  advisable  to  quarantine  entire  or- 
ganizations as  suspects,  or  to  direct  the  measure  against 
towns  or  communities. 

Isolation  cannot  be  made  an  effective  measure  of 
disease-prevention  unless  it  includes  all  cases  of  the 
disease  in  question,  and,  in  many  instances,  all  sus- 


ALIMENTARY  TRACT  INFECTION        247 

pected  cases.  It  is,  therefore,  essential  that  all  cases 
and  suspects  be  promptly  reported  to  the  central  au- 
thority, in  order  that  proper  steps  may  be      _,  . 

taken.    It  is  only  rarely  that  difficulty  will  _ 

1  .         1^          -0.            J    ^1        M-  Bory  Re- 

arise  in  this  matter  as  it  regards  the  mili-  ' . 

,     ,    .               '^            .  .,.  porting 

tary  personnel ;  but  cases  among  civilians  t  r* 

and  residents  of  the  locality  in  which  the 
troops  are  quartered  may  be  willfully  concealed.  Epi- 
demics "  hurt  business,"  and  often  interfere  with  trans- 
portation and  traffic,  and  for  this  reason  and  others  it 
is  not  uncommon  that  great  efforts  are  made  to  hide  or 
deny  their  existence. 

It  therefore  occasionally  becomes  necessary  to  make 
regular  and  frequent  inspections  and  examinations  of 
all  persons  in  camp,  and  less  frequently  of  _,  .  , 
those  in  the  neighborhood.  If  the  commu-  _ 
nity  is  under  military  control,  this  may  be  a  . 
relatively  simple  matter,  but  where  such  is 
not  the  case  it  may  be  one  of  extreme  difficulty,  and  call 
for  the  display  of  much  forbearance,  good  temper,  and 
tact.  When  such  measures  are  necessaiy,  they  should  be 
under  the  charge  and  direction  of  medical  officers  who 
will  see  that  they  thoroughly  accomplish  their  purpose, 
but  at  minimum  of  inconvenience,  and  that  they  are 
conducted  in  such  a  manner  as  to  gain  rather  than  alien- 
ate the  sympathy  and  the  cooperation  of  the  civil  pop- 
ulation and  its  medical  practitioners.  If  many  sick 
are  found  it  may  be  necessary,  in  order  to  control  the 
epidemic,  to  establish  large  isolation  camps  and  special 
hospitals  for  civilians.  The  gathering  of  large  crowds 
from  many  places,  as  in  pilgrimages,  fairs,  and  religious 
festivals,  should  be  particularly  forbidden  during  chol- 
era epidemics.    Health-inspections  may  also  be  made 


248       THE  PREVENTION   OF  EPIDEMICS 

the  means  of  much  sanitary  instruction,  and  may  thus 
do  great  good  in  addition  to  that  accruing  from  a  know- 
ledge of  the  location  of  cases.  Such  inspection,  exami- 
nations, and  instructions  have  been  resorted  to  in  times 
of  cholera  epidemics,  and  among  peoples  living  under 
military  control,  with  great  success.  They  redound  to 
the  benefit  of  the  civil  as  well  as  the  military  population. 
Inspections  of  troops  for  the  presence  of  disease  are  not 
infrequently  resorted  to,  and  often  do  much  good. 

Every  case  of  any  of  these  diseases  that  is  reported 
or  discovered  should  be  investigated  as  thoroughly  as 
T  *j        possible  as  to  its  origin.   This  investigation 

may  show  no  results  in  single  cases,  but 
p,  when  the  findings  in  many  cases  are  com- 

pared they  may  give  important  information 
as  to  the  cause  of  the  epidemic.  Thus  it  may  be 
found  that  it  is  confined  to  persons  using  a  certain  water, 
to  those  consuming  milk  sold  by  a  special  dealer,  or 
who  eat  the  productions  of  a  certain  cook,  or  who  have 
partaken  of  shellfish ;  or  that  the  cases  are  otherwise 
connected  in  some  way.  The  information  thus  gained 
may  direct  attention  to  the  cause  of  an  epidemic,  and  its 
removal  may  put  an  end  to  the  whole  matter.  The  trac- 
ing of  epidemics  is,  however,  often  a  difficult  matter, 
and  the  detection  of  typhoid-carriers  is  particularly  so. 
If,  for  instance,  a  carrier  were  put  on  kitchen  police  for 
a  day  and  infected  the  food  of  a  company,  a  dozen  men 
might  contract  the  disease  as  a  result.  They  might  de- 
Telop  it,  however,  in  from  one  to  three  weeks,  or  possibly 
more,  and  meanwhile  a  large  number  of  men  may  have 
worked  in  the  kitchen,  and  many  other  factors  having 
an  apparent  bearing  may  have  come  to  light,  so  that  all 
thought  is  diverted  from  the  man  really  causing  the 


ALIMENTARY  TRACT  INFECTION        249 

trouble.  However,  the  report  of  a  well-studied  carrier- 
caused  epidemic  of  93  cases  in  Hanford,  California,  in 
1914,  showed  that  more  cases  developed  on  the  sixth 
than  on  any  other  day,  two  thirds  of  all  cases  appeared 
by  the  tenth  day,  and  one  case  developed  in  three  days. 

In  very  many  instances  the  cause  of  the  epidemic  can- 
not be  ascertained,  or  at  least  not  soon  enough  to  permit 
its  removal  in  time  to  prevent  numerous  infections,  and 
protection  must  be  sought  in  the  practice  of  such  general 
preventive  measures  as  are  applicable.  These  should 
take  into  consideration  the  various  methods  in  which 
the  diseases  are  transmitted,  and  will  embrace  the  fol- 
lowing. 

Cleanliness  of  persons,  tents,  kitchens,  and  camps  is 
of  paramouut  importance,  and  officers  should  encourage 
it  by  precept,  example,  orders,  and,  if  nee-  ^  . 

essary,  punishment.  Those  associated  with  -_ 
the  sick  should  be  particularly  careful  as 
to  their  persons,  surroundings,  and  food.  They  should 
keep  clean  tents,  wash  themselves  frequently,  disin- 
fect their  hands  after  handling  the  sick,  their  bedding, 
clothing,  or  other  personal  belongings,  should  be  care- 
ful not  to  use  the  same  drinking  or  eating  utensils, 
and  in  other  ways  should  avoid  the  dangers  of  contact. 
Disinfection  of  clothing,  bedding,  tents,  rooms,  bar- 
racks, urinals,  latrines,  and  all  the  things  used  by  the 
sick  man,  should  follow  his  removal  from  the  barracks, 
tent,  camp,  or  temporary  hospital.  Articles  that  cannot 
be  well  disinfected,  such  as  hats  and  leather  gloves, 
should  be  destroyed  if  probably  infected.  Latrines  that 
are  infected  should  be  disinfected  as  well  as  possible, 
and,  if  pits  or  other  cheap  arrangements,  closed.  Great 
care  should  be  taken  to  make  sure  that  all  latrines  are 


250       THE  PREVENTION   OF  EPIDEMICS 

fly-proof.  General  good  hygiene  should  prevail.  Sun- 
shine and  fresh  air  should  be  provided  in  abundance  to 
destroy  and  dilute  the  poison  ;  temperance,  order,  and 
regularity  of  habits  encouraged,  overwork  and  idleness 
alike  avoided,  and  cheerful  and  rational  living  enjoyed. 
The  ground  should  be  kept  so  clean  as  to  leave  no 
opportunity  for  fecal  or  urinary  contamination  of  shoes, 
no  breeding-places  or  food-supplies  for  flies  or  roaches, 
and  no  infected  dust  to  blow  about.  The  effect  of  not 
doing  these  things  is  seen  more  promptly  in  cholera 
than  in  typhoid,  because  the  incubation  period  in  the 
former  is  shorter  and  effects  become  manifested  before 
causes  are  forgotten.  In  that  instance,  lack  of  sunshine, 
intemperance  in  food  and  drink,  fear,  and  unhygienic 
surroundings  are  regarded  as  important  predisposing 
causes  of  the  disease.  Increased  care  and  attention 
should  be  given  to  the  disposal  offeces^  urine,  vomit^ 
and  other  wastes,  and  to  the  elimination  of  fiie&  and 
other  insects  and  protection  from  them.  Cremation  of 
waste  materials  should  be  resorted  to  if  practicable. 
Men  should  be  instructed  to  use  only  the  latrines  and 
urinals  of  their  own  companies  so  far  as  it  is  possible 
to  do  so,  and  under  no  circumstances  to  urinate  or  defe- 
cate on  the  ground.  The  Reed  Board  reported :  "  (15.) 
Camp  pollution  was  the  greatest  sin  committed  by  the 
troops  in  1898." 

Cleanliness  of  camp-sites  and  good  general  police  are 
therefore  of  very  great  importance,  both  as  preventing 
accumulations  of  infective  material  and  as  keeping 
down  flies  and  other  vermin.  The  Reed  Board  pub- 
lished an  important  conclusion  bearing  on  this :  — 

"  (37.)  The  fact  that  a  command  expects  to  change 
its  location  does  not  justify  neglect  of  the  proper  polic- 


ALIMENTARY  TRACT  INFECTION        251 

ing  of  the  ground  occupied.  ...  A  camp-site  should 
be  thoroughly  policed  up  to  the  moment  of  vacating  it. 
This  should  be  insisted  upon  as  a  matter  of  military 
discipline,  and  camp  commanders  should  regard  proper 
attention  to  the  sanitation  of  the  site  occupied  by  their 
troops  as  one  of  their  highest  duties,  and  its  neglect  as 
a  crime." 

Recent  experiments  show  that  typhoid  bacilli  can  re- 
tain their  virulence  in  soil  for  several  weeks  or  months. 

When,  because  of  want  of  foresight,  neglect,  or  for 
any  other  reason,  a  command  is  located  on  a  polluted 
site,  a  change  may  be  desirable.   This  can- 
not  be  depended  upon  to  rid  the  command       r  cs- 
of  infection;  and  disinfection,  isolation,  and 
the  other  measures  herein  advocated  must  continue  to 
be  used,  but  the  change  may  at  any  rate  reduce  the 
number  of  channels  of  infection.  The  dust  blown  about 
camp  would  be  less  dangerous,  the  number  of  flies 
smaller,  and  the  opportunities  for  fecal  contaminations 
fewer,  in  the  new  camp. 

The  water  used  for  drinking,  dishwashing,  and  sim- 
ilar purposes  can,  of  course,  be  sterilized  by  boiling  ;  but 
as  many  men  seek  other  water  to  drink,  it  is     .^ 
desirable  that  only  a  pure  supply  be  avail- 
able,  and  if  one  purified  by  large  filtration  '^^  ^ 

plants  or  other  means  is  to  be  obtained,  it  should  be. 
At  times  it  may  be  necessary  to  take  steps  to  guard  the 
purity  of  a  supply  known  to  be  good.  Reservoirs,  fil- 
ters, or  watersheds  may  need  to  be  patrolled  to  prevent 
their  contamination.  Bathing  in  drinking  -  supplies 
should  of  course  be  prevented.  The  rule  to  be  followed 
always  in  time  of  epidemics  is,  however,  to  drink  no 
water  not  purified  by  heat.   No  matter  how  good  a 


252       THE  PREVENTION  OF  EPIDEMICS 

general  supply  is  to-day,  the  possibilities  of  infection 
are  so  many,  and  so  hard  to  guard  against,  that  there 
is  no  certainty  as  to  the  purity  of  to-morrow's  supply. 

Ice,  unless  made  from  distilled  water  and  handled 
with  all  possible  care,  should  not  be  allowed  to  come 
in  contact  with  articles  of  food  or  drink  during  the 
prevalence  of  epidemics.  It  may  contain  germs  frozen 
in  it,  or  they  may  have  been  deposited  on  the  surface 
by  improper  handling. 

The  safest  rule  as  to  foods  is  the  same  as  that  just 
applied  to  water,  —  to  take  none  that  is  not  sterilized. 
_,     J  This   rule   is   pretty  generally  applied  by 

«        ,  Americans  in  the   Philippines,  especially 

during  cholera  epidemics,  but  it  has  not 
had  such  general  application  in  our  own  country  or  as  a 
measure  of  defense  against  typhoid.  Heat  is  the  means 
of  sterilization  for  most  foods,  and  cooking  the  method 
of  applying  it.  However,  such  articles  as  bananas, 
mangoes,  apples,  cucumbers,  melons,  that  are  protected 
by  a  thick  skin  or  rind,  may  be  washed  in  bichloride 
or  other  antiseptic  solution,  and  later  peeled.  The  use 
of  pies,  soft  drinks,  milk,  and  similar  articles  sold  by 
peddlers,  is  in  general  to  be  deprecated,  and  it  may 
be  advisable  to  stop  such  sales.  Green  vegetables  may 
also  have  to  be  banned,  particularly  in  cholera  times 
and  where  dysentery  and  the  practice  of  manuring 
with  human  feces  coexist.  If  either  typhoid  or  cholera 
appears  in  the  person  or  family  of  a  dealer  in  food- 
stuff or  milk,  his  business  should  be  stopped  at  once,  or 
allowed  to  continue  only  under  such  rigid  rules  as  will 
destroy  all  chance  of  dissemination  of  the  infection.  If 
the  person  cannot  be  controlled  by  military  authority, 
the  soldiers  should  be  forbidden  to  deal  with  him. 


ALIMENTARY   TRACT  INFECTION        253 

Typhoid,  cholera,  and  bacillary  dysentery  are  all  dis- 
eases in  which  protective  value  has  been  attributed  to 
the  injection  of  the  living  or  killed  germs 
beneath  the  skin,  the  procedure  commonly         ^ 
spoken  of  as  vaccination  against  the  dis- 
eases. Vaccination  against  dysentery  has  had  relatively 
little  use,  but  good  results  have  been  claimed.  The  use 
of  cholera  vaccine  has  been  mueh  more  extensive,  and  in 
India,  Japan,  the  Philippines,  and  elsewhere  the  results 
have  been  considered  most  encouraging.    According  to 
statistics  published  in  1913  by  the  originator  of  the 
most  widely  used  cholera  vaccine,  it  appears  to  reduce 
both  the  morbidity  and  death  rates  to  about  one  seventh 
of  what  they  are  among  the  unvaccinated. 

The  latest  available  figures  relating  to  this  vaccine 
are  those  concerning  its  use  in  the  Gi'cek  army  at  the 
end  of  the  Balkan  war.  Following  an  extensive  out- 
break of  cholera  in  the  army  and  the  territory  occupied 
by  it,  150,000  troops  and  350,000  civilians  were  vacci- 
nated. The  attempt  was  made  to  give  two  injections  at 
an  interval  of  eight  days.  The  immediate  effects  of  the 
injections  were  not  such  as  to  prevent  military  duty,  and 
were  probably  much  like  those  following  the  use  of  our 
typhoid  prophylactic.  In  the  whole  army  about  19  per- 
sons per  1000  developed  cholera.  Among  the  unvacci- 
nated the  incidence  was  93  per  1000  and  the  mortality 
was  27.5  per  cent  of  the  sick.  Among  those  who  had 
one  injection  the  incidence  was  42  per  1000,  with  a 
mortality  of  12.2  per  cent,  and  among  those  having  two 
injections  it  was  7  per  1000  with  a  mortality  of  10.2 
per  cent.  That  this  entire  improvement  was  due  to  the 
use  of  vaccine  is  improbable,  but  how  much  of  it  was  due 
to  improved  measures  of  sanitation  and  to  the  general 


254       THE  PREVENTION   OF  EPIDEMICS 

dissemination  of  knowledge  of  the  methods  of  preven- 
tion that  must  have  gone  into  effect  as  the  vaccination 
progressed  is  not  known. 

Typhoid  vaccine,  or  prophylactic,  as  it  is  officially  des- 
ignated, has  had  its  most  extensive  use  in  our  own  army, 
and  the  results  have  been  so  good  that  its  use  has  there 
been  compulsory  and  universal  since  1911.  Typhoid 
has  now  practically  disappeared  from  the  United  States 
army,  its  incidence  and  mortality  for  seven  years  being 
shown  in  the  following  table  :  — 

Typhoid  Incidence  and  Deaths  per  1000  Persons  in 

the  U.S.  Army 

Year  Cases  Deaths 

1907  3.53  0.19 

1908  2.94  0.23 

1909  3.03  0.28 

1910  2.32  0.16 

1911  0.89  0.11 

1912  0.26  0.03 

1913  0.03  0.00 

Just  how  much  of  the  reduction  shown  here  is  due 
to  the  use  of  prophylactic  and  how  much  to  other  fac- 
tors it  is  impossible  to  say.  In  his  annual  report  for 
1913  the  Surgeon  General  sai<i,  "  It  must  be  especially 
emphasized  that  there  has  been  no  lessening  of  the 
efforts  in  the  army  to  prevent,  by  improved  sanitary 
measures,  the  occurrence  of  typhoid  infection.  Advances 
in  the  other  sanitary  measures  have  gone  on,  hand  in 
hand,  with  the  extension  of  the  typhoid  prophylaxis." 

It  must  be  emphasized  also  that  no  one  is  justified, 
because  of  his  use  of  typhoid  vaccine,  in  neglecting  to 
care  for  himself  or  his  fellows  in  all  known  ways. 


CHAPTER  XIII 

DISEASES  DUE  TO   INFECTION  THROUGH  THE 
RESPIRATORY   TRACT 

To  group  the  diseases  discussed  in  this  chapter  under 
the  above  heading  may  be  somewhat  misleading,  but  as 
it  is  thought  that  all  of  them  do  frequently  gain  admission 
to  the  body  by  way  of  the  respiratory  tract,  and  some  of 
them  always,  as  the  above  caption  is  less  misleading 
than  the  phrase  "air-borne  diseases,"  and  as  the  group 
cannot  be  considered  as  conveniently  and  satisfactorily 
in  the  preceding  or  the  following  chapters  as  in  this, 
the  grouping  is  considered  justifiable. 

Most  of  those  now  to  be  treated  of  are  also  known 
as  contagious  diseases.  The  term  is  elastic  and  may 
be  used  in  different  senses,  but  as  ordinarily  applied  to 
the  diseases  discussed  in  this  chapter  it  may  be  taken 
to  mean  that  they  are  more  readily  transmissible  than 
most  others  and  are  very  apt  to  spread,  especially  by 
contact  or  association. 

The  principal  diseases,  from  a  military  standpoint, 
in  this  group  are  measles,  scarlet  fever,  German  mea- 
sles, smallpox,  chickenpox,  influenza  or  grippe,  mumps, 
whooping-cough,  diphtheria,  tonsillitis,  epidemic  men- 
ingitis, and  acute  anterior  poliomyelitis  or  infantile 
paralysis.  It  is  true,  though,  that  tuberculosis,  pneu- 
monia, pneumonic  plague,  and  some  other  diseases  are 
sometimes  widely  spread  in  the  same  way. 

Some  of  the  diseases  mentioned  above  —  influenza, 


256       THE  PREVENTION   OF  EPIDEMICS 

tuberculosis,  diphtheria,  meningitis,  tonsillitis,  plague, 

^  .         and   whooping-cough  —  are  known  to   be 

Causative  j  u    i     ..    •  i  xi. 

O  an     ama  ^^^^^^  "Y  uacteria,  and  the  organisms  can 

be  isolated  and  identified.  The  causes  of 
measles,  German  measles,  scarlet  fever,  and  smallpox 
are  still  unknown,  and  it  is  possible,  though  not  certain, 
that  they  are  due  to  organisms  invisible  with  our  micro- 
scopes. Supposedly  causative  organisms  have  been  de- 
scribed for  each  of  them,  but  convincing  proof  of  the 
relationship  has  in  no  instance  been  produced. 

Certain  factors  have  an  important  influence  in  pre- 
disposing to  some  of  these  diseases,  and  enable  us  to 
p     -.  exercise  some  measure  of  control  over  them. 

.  Most  of  them  are  so  prevalent  in  the  very 

^  young  as  to  be  known  as  "  the  diseases  of 

childhood."  By  this  phrase  we  usually  speak 
of  the  group  including  mumps,  measles,  scarlet  fever, 
German  measles,  chicken-pox,  and  diphtheria.  Before 
the  era  of  vaccination,  smallpox  was  also  principally  a 
disease  of  childhood,  and  produced  its  greatest  mortal- 
ity among  those  under  five  years  of  age.  Thus  in  "  Ge- 
neva from  1580  to  1760  there  were  25,349  deaths  from 
smallpox,  and  of  these  21,078  were  under  five  years 
old  and  961  per  1000  were  under  ten  years  old.  In 
Edinburgh  in  1764-83,  the  proportion  under  ten  years 
old  was  993  per  1000.  In  the  Chester  epidemic  of  1774 
there  were  202  deaths,  all  among  children  under  ten 
years  old."  All  of  these  diseases  do  attack  adults,  how- 
ever, though  less  frequently  and  usually  less  severely 
than  children. 

Season  exercises  some  influence.  The  cold,  raw 
weather  of  the  late  winter  and  early  spring  particularly 
favor  most  of  them,  while  they  are  also  commoii  in  wIq- 


RESPIRATORY   TRACT   INFECTION       257 

ter  and  rather  rare  in  summer.  Infantile  paralysis,  how- 
ever, is  more  apt  to  occur  in  summer  than  at  other  times, 
which  fact  is  one  of  the  several  used  as  arguments  that 
the  disease  is  conveyed  by  the  common  biting  stable  fly, 
Stomoxys  calcitrans. 

Crowding  favors  epidemics,  quite  apart  from  the 
question  of  ventilation,  and  it  also  predisposes  to  severe 
attacks.  Many  cases  of  a  very  severe  type  of  measles 
developed  in  the  concentration  camps  in  1898,  and  an 
epidemic  of  600  cases  occurring  at  Columbus  Barracks 
between  December,  1910,  and  May,  1912,  was  thought 
to  have  been  aggravated  by  crowding.  School  epidem- 
ics of  measles,  German  measles,  scarlet  fever,  mumps, 
and  diphtheria  are  rather  common. 

Poor  hygienic  conditions,  such  as  dirty  surround- 
ings, the  breathing  of  effluvia  from  decomposing  matter, 
and  bad  ventilation,  are  all  thought  to  predispose  to  them, 
and  probably  do  so  by  reason  of  the  fact  that  persons 
exposed  to  such  influences  are  pretty  sure  to  be  living 
in  such  a  manner  as  to  be  subjected  to  unusual  oppor- 
tunities for  too  close  contact  with  neighbors. 

Unhnown  atmospheric  conditions  apparently  influ- 
ence the  rise  and  fall  of  some  of  them.  Influenza  and 
diphtheria  increase  and  decrease  in  ways  thus  far  not 
fully  explained. 

A  previous  attack  of  one  of  these  diseases  usually 
protects  from  a  second,  but  such  is  not  the  case  in  all  of 
the  group.  One  attack  of  diphtheria  or  influenza,  for 
instance,  seems  to  predispose  to  a  second  rather  than  to 
protect  against  it.  Second  attacks  of  smallpox,  scarlet 
fever,  and  mumps  are  rare,  those  of  measles  less  so. 

These  diseases  are  not  all  transmitted  in  exactly  the 
s^me  way,  but  the  transfer  of  no  one  of  them  is  so 


258       THE  PREVENTION   OF  EPIDEMICS 

limited  as  the  title  of  the  chapter  would  indicate  ;  so 

liiT  ii.   -a       the  various  methods  will  be  considered  and 

Saetnoos      .  ^.  . 

of  Tra   «  exceptions  noted  as  we  progress. 

.     .  Some  of  these  affections  are  coutaffious 

mission       X         1       1  1  11 

to  such  a  degree  that  near  approach  to  the 

patient  and  breathing  of  the  air  surrounding  him  in 
a  greater  or  smaller  zone,  without  any  contact,  seems 
-  .  sufficient  to  allow  infection.   This  is  par- 

^-  ticu.arlytrueof.easles,b.,titiss„fficieLy 

true  of  all  the  diseases  of  the  group  to  make  isolation 
ordinarily  worth  while  as  a  matter  of  routine  in  mili- 
tary practice,  and  this  is  none  the  less  true  because  of 
the  fact  that  transmission  of  most  of  the  diseases  of  the 
group  is  by  contact,  rather  than  by  air-borne  infection. 
The  following  excellent  observations  that  bear  on  this 
point  were  published  in  the  London  Lancet  of  June 
13,  1914. 

In  a  common  open  ward  with  good  ventilation,  hav- 
ing twelve  beds  and  an  allowance  of  195  square  feet 
of  floor  space  and  15  linear  feet  of  wall  space  per  bed, 
there  were  treated  in  two  years  274  patients  with  332 
cases  of  contagious  diseases,  including  112  cases  of  scarlet 
fever,  63  of  diphtheria,  24  of  chickenpox,  47  of  whoop- 
ing cough,  11  of  mumps,  2  of  incipient  measles,  6  of 
German  measles.  At  each  patient's  bed  were  a  table, 
eating  utensils,  towels,  gowns  for  nurse  and  doctor,  and 
such  things  as  the  patient  needed.  No  toys,  books, 
or  other  articles  that  would  be  apt  to  be  passed  from 
one  patient  to  another  were  allowed  in  the  ward.  On 
entering  the  ward  every  officer  or  person  who  was  to 
touch  a  patient,  his  bed,  or  anything  connected  with 
him  had  to  scrub  his  hands  and  nails  with  soap,  water, 
and  1  to  200  solution  of  lysol  at  the  bedside,  to  put  on 


RESPIRATORY  TRACT  INFECTION    259 

a  gowu  reserved  for  that  bed,  and,  having  finished,  to 
remove  the  gown  and  scrub  again  before  leaving  the 
bed.  Under  this  regime  secondary  cases  occurred  as  fol- 
lows :  Scarlet  fever,  two  cases,  due  to  a  nurse ;  diph- 
theria, none  ;  German  measles,  none  ;  mumps,  none  ; 
whooping-cough,  five  cases  ;  chickenpox,  eight  cases ; 
which  facts  the  reporters  regarded  as  tending  to  show 
that  diphtheria,  scarlet  fever,  and  mumps  are  not  air- 
borne, that  measles  and  chickenpox  are  so  in  their  early 
stages,  but  not  after  the  third  or  fourth  day,  and  that 
whooping-cough  is  probably  so  for  an  indefinite  period. 

As  showing  the  very  high  degree  of  contagiousness 
of  measles  in  its  early  stages  it  is  well  to  cite  instances 
from  two  official  health  bulletins.  In  Chicago  thirteen 
children  attended  a  birthday  party,  two  of  them  hav- 
ing "  colds."  Next  day  both  of  these  two  had  typical 
measles.  After  eleven  to  fourteen  days  every  child  of 
the  party,  except  one  who  had  had  the  disease  within 
a  year,  had  measles.  One  of  them  developed  a  cold 
twelve  days  after  the  party,  and  she  was  taken  from 
her  convent  school-room  and  put  for  a  short  time  (an 
hour  or  less)  in  a  large  room  with  fourteen  larger  girls. 
Twelve  days  later  all  fourteen  of  those  girls  developed 
measles.  Some  of  these  then  started  epidemics  and  forty- 
seven  cases  were  known  to  result  from  the  first  one. 
Aerial  transmission  of  the  contagion  seemed  very  evident 
in  the  school-room,  where  contact  could  be  ruled  out. 

"  A  farmer  and  stockman  from  the  little  town  of  A. 
went  to  Kansas  City  with  a  carload  of  cattle.  Nine  days 
later  he  had  a  bad  cold.  He  spent  two  days  wandering 
from  store  to  store  in  the  little  town  telling  his  friends 
what  a  fearful  thing  his  cold  was.  On  the  third  day  the 
eruption  occurred  and  his  physician  tacked  up  a  measles 


260       THE   PREVENTION  OF  EPIDEMICS 

sign  on  the  house.  But  it  was  too  late.  Two  weeks  later 
28  of  his  friends  who  had  listened  sympathetically  to  his 
'  cold '  troubles  also  had  measles.  In  two  weeks  more 
28  other  cases  resulted,  and  two  weeks  later  30  cases  — 
86  in  all.  That,  being  nearly  the  entire  population  of 
the  town,  ended  the  epidemic  in  that  community.  But  of 
the  first  crop  of  28  cases  at  A.  one  visited  the  home  of 
a  physician  in  the  city  of  B.  The  physician,  not  know, 
ing  his  child  was  exposed,  permitted  its  attendance  at 
school  regularly,  and  the  child  '  broke  out '  in  school. 
From  this  child  it  spread  to  43  families,  or  90  cases.  A 
visitor  from  the  city  of  C.  in  the  town  of  A.  came  home, 
attended  the  city  schools  of  C.  and  the  disease  spread 
to  over  100  cases  there.  During  the  county  examina- 
tions held  in  C,  and  at  the  height  of  the  epidemic 
there,  a  pupil  from  the  city  schools  of  D.  was  exposed 
to  the  infection.  In  spite  of  this  knowledge  this  pupil 
did  not  cease  school  attendance,  and  thirty  cases  re- 
sulted in  D." 

Healthy  persons  may  be  carriers  of  and  may  convey 
diphtheria,  cerebro-spinal  meningitis,  and  infantile  pa- 
ralysis ;  while  persons  apparently  recovered 
V/am  from  them  but  still  harboring  the  germs 

may  convey  the  diseases  just  named,  influenza,  and 
scarlet  fever. 

Fomites  conveyance  of  infection  is  of  course  a  form 
of  mediate  contact.  It  is  more  apt  to  occur  the  more 
recent  the  contact  of  the  fomites  with  the 
sick  person,  as  time,  sunlight,  drying,  and 
other  factors  constantly  tend  to  destroy  the  causative 
organisms  unless  these  be  on  substances  offering  them 
food  and  favorable  conditions,  such  as  milk,  meats,  iind 
other  articles  of  human  food.  It  is  for  this  reason  that 


RESPIRATORY  TRACT  INFECTION        261 

terminal  disinfection  of  houses  after  the  occurrence 
of  these  diseases  has  of  late  been  found  to  be  much 
less  important  than  it  was  formerly  considered  to  be,  with 
the  result  that  it  has  been  almost  abandoned  in  several 
cities.  Of  the  fomites  the  most  dangerous  are  toys, 
handkerchiefs,  and  such  other  things  as  come  into  close 
contact  with  the  patient,  and  especially  such  as  are  apt 
to  be  contaminated  with  the  secretions  from  his  nose, 
mouth,  or  other  parts.  It  is  often  extremely  difficult 
to  draw  hard  and  fast  lines  separating  air-conveyance, 
dust-  and  droplet-infection,  fomites-oonveyance,  and  in- 
fection by  direct  contact.  Where  there  has  been  a  pos- 
sibility of  infection  in  one  of  these  ways  there  have  often 
been  other  opportunities  for  it.  Infection  by  direct  con- 
tact we  know  to  be  possible  in  all  these  diseases,  and 
kissing  or  sleeping  with  a  person  having  any  of  them  is 
particularly  dangerous.  They  are  dangerous  cases  to 
nurse  or  to  treat,  and  nurses  and  doctors  r^  a.  ^ 
ofteu  contract  them,  and  would  do  so  much 
oftener  except  for  the  protecting  influences  of  previous 
attacks,  age,  and  constant  sanitary  precautions. 

The  virus  of  most  of  these  affections  is  given  off  in 
the  spit  and  nasal  secretions  of  persons  suffering  from 

them.    Such  is  certainly  the  case  in  diph-    ^ 
,     .  1     r  1  1  Sputum 

thena,  scarlet  fever,  measles,  mumps,  whoop-      *^ 

ing-cough,  poliomyelitis,  and  sometimes  in  meningitis, 

and  it  may  be  true  of  all  the  others. 

It  is  quite  probable  that  the  virus  of  some  or  all  of 

these  diseases  may  also  be  contained  in  other    -^. ,       « 

,  •  r  1  .  Other  Se- 

natural  secretions  of  the  patient,  or  in  pus 

crcuions 
or  eruptions  that  sometimes  occur.    It  is 

highly  probable   that  the  ears  may  be  infectious  in 

measles,  and  discharges  from  the  ears  and  nose  are 


262       THE   PREVENTION   OF  EPIDEMICS 

certainly  so  in  scarlet  fever.  The  virus  of  poliomyelitis 
has  been  demonstrated  in  the  lining  membrane  of  the 
stomach  and  bowels. 

The  eruption  of  smallpox  consists  at  different  periods 
of  papules  or  pimples,  vesicles  or  little  blisters,  and 
g,,.  scabs.    Both  the  vesicle  contents  and  the 

scabs  are  known  to  contain  the  virus  of  the 
disease  and  are  therefore  to  be  avoided.  While  proof 
is  lacking  that  the  similar  products  of  chickenpox  and 
the  scales  or  strips  of  skin  shed  after  measles  or  scar- 
let fever  are  dangerous,  it  is  the  part  of  wisdom  to  avoid 
them  also  and  to  burn  them  as  they  are  cast  off. 

In  most  or  all  of  the  diseases  here  considered  the 
virus  is  at  some  time  contained  in  the  blood,  and  contact 
with  that,  as  in  dressing  wounds  or  clean- 
ing up  spilled  blood,  would  probably  offer 
chances  of  infection. 

The  introduction  of  infectious  matter  into  wounds 
serves  to  inoculate  most  of  these  affections.  It  is  much 
_  ,  resorted  to  in  efforts  to  infect  animals  for 

^  experimental  or  other  purposes,  and  in  pre- 

vaccination  times  inoculation  with  smallpox 
was  sometimes  done  as  tending  to  produce  a  milder 
attack  of  the  disease  than  resulted  from  natural  infec- 
tion. 

Infection  through  the  medium  of  utensils,  such  as 
cups,  spoons,  thermometers,  bedpans,  or  pipes,  may 
-..  .,  readily  occur,  but  is  an  evidence  of  mediate 
contact  rather  than  of  contagion  by  virus 
contained  in  the  air.  Such  articles  can  only  rarely  con- 
vey the  disease  in  question,  unless  they  have  been  soiled 
by  contact  with  the  mouth,  skin,  or  other  parts,  or  the 
secretions  of  a  patient. 


RESPIRATORY  TRACT  INFECTION       263 

Animals  may  convey  these  diseases  in  various  ways. 
They  may  gather  up  infected  dust,  sputum,  or  flakes 
of  skin  by  lying  on  or  near  the  sick-bed,  .  .  , 
and,  by  shaking  themselves,  liberate  it  else- 
where. It  is  possible  that  they  might  lick  up  moist 
sputum  or  other  secretions,  and  retain  the  germs  alive 
in  their  mouths  and  transmit  them  through  fondling  or 
fawning,  even  though  they  do  not  themselves  have,  or 
are  not  subject  to,  the  disease.  In  other  instances  they 
are  subject  to  the  diseases,  and  may  contract  them 
through  contact  from  eating  spit,  or  in  other  ways,  and 
breed  and  give  off  germs  just  as  do  human  patients. 
Cats,  dogs,  and  many  other  animals  are  subject  to  diph- 
theria, and  may  aid  in  spreading  it.  Cows  suffer  from 
a  disease  of  the  teats  which,  it  has  been  said,  can  by 
means  of  milk  set  up  scarlet  fever  in  the  human  sub- 
ject. Cattle  suffer  from  smallpox  in  the  mild  and  al- 
tered form  known  as  vaccinia  or  cowpox,  which,  when 
in  turn  inoculated  into  man,  affords  protection  against 
the  first,  or  more  severe  disease.  Whooping-cough  has 
been  transmitted  to  animals  experimentally. 

Epidemics  of  scarlet  fever  and  diphtheria  have  many 
times  been  traced  to  contaminated  milk,  and  it  is  not 

impossible  that  several  of  the  other  diseases     __.,, 

J-  Ti      •     V,  Milk 

we  are  discussing  may  likewise  be  so  con- 
veyed. The  milk  may,  in  exceptional  instances  and  in 
the  two  diseases  just  named,  be  infected  by  the  animal 
giving  it,  but  the  virus  is  usually  if  not  always  derived 
from  some  human  carrier  of  the  organisms.  Milk  is  a 
good  culture  medium  for  most  disease-producing  bac- 
teria, and  we  have  already  seen  how  important  it  may 
be  in  the  diffusion  of  typhoid  fever  and  how  readily  it 
may  be  infected  with  the  germs  of  that  disease.  It  is 


264       THE  PREVENTION   OF  EPIDEMICS 

therefore  easily  conceivable  how  milk-baudlers  suffering 
from  influenza,  mild  diphtheria,  mild  scarlet  fever,  or 
others  of  the  diseases  we  have  been  discussing,  might, 
through  coughing,  tasting  the  milk,  careless  handling  of 
vessels,  or  in  other  ways,  introduce  germs  into  it.  Milk 
epidemics  of  scarlet  fever,  like  those  of  typhoid,  are  apt 
to  show  a  somewhat  "  explosive "  character,  that  is, 
many  cases  develop  at  or  near  the  same  time.  In  Bos- 
ton, Baltimore,  and  Chicago  very  large  epidemics  of 
septic  sore-throat  have  been  traced  to  infected  milk. 
The  following  milk-borne  epidemics  of  the  diseases  here 
considered  have  been  investigated  in  Boston  :  — 

In  1907,    717  cases  of  scarlet  fever  from  one  milk  supply. 
"      "         72    "     "diphtheria  "     "     "       ♦' 

"1910,   842    "     "scarlet  fever        "     "     "       " 
"  1911,1000    "     "septic sore-throat"     "     "       " 
Measles  is  not  thought  to  be  milk-borne. 

The  virus  of  any  disease  having  gained  entrance  to 
a  susceptible  body,  some  time  is  required  for  its  mul- 
tiplication and  development,  and  for  it  to 
incu     -      manifest  its  effects  on  the  body.  This  time 
_  between  the  entrance  of  infection  and  the 

appearance  of  the  first  symptoms  of  disease 
is  known  as  the  incubation  period,  and  is  more  or  less 
constant  for  each  disease.  As  it  is  important  to  take 
this  into  consideration  in  attempting  to  trace,  control, 
or  prevent  epidemics,  the  following  may  be  considered 
as  representing  it  with  tolerable  accuracy  in  the  diseases 
named :  — 


RESPIRATORY  TRACT  INFECTION       265 

Diseases  Incubation  Pkbiods 

Smallpox 8  to  20  days,  oftenest  12. 

Chickenpox       .     .     .     .  10  to  15  days. 

Scarlet  fever     .     .     .     .  1  to  7,  oftenest  2  to  4  days. 

Measles 7  to  18,  usually  14  days. 

German  measles    ...  14  days  or  more. 

Mumps 14  to  21  days. 

Whooping-cough  .     .     .  7  to  10  days. 

Influenza 1  to  4  days. 

Diphtheria 1  to  7  days,  usually  2. 

Tonsillitis 1  to  3  or  4  days,  usually  2. 

Poliomyelitis    .     .     .     .  3  to  33  days,  usually  8  or  9. 

The  incubation  period  is  of  value  in  enabling  us  to 
approximate  the  time  and  plaee  of  infection  and  to  judge 
correctly  of  the  length  of  time  that  suspects 
should  be  isolated.  After  the  disease  has  J» 

developed,  however,  the  character  and  length 
of  the  isolation  period  for  the  sick  will  be 
controlled  rather  by  the  degree  of  the  con- 
tagiousness and  the  time  at  which  it  is  ^ 
gi'eatest  or  during  which  it  persists.  It  will 
therefore  be  well  to  summarize  briefly  our  knowledge  on 
those  points. 

Smallpox  is  one  of  the  most  contagious  of  diseases, 
and  prior  to  the  introduction  of  vaccination  almost  every- 
body had  an  attack,  usually  in  childhood,  as  natural 
immunity  is  very  rare.  It  is  probably  contagious  from 
an  early  stage,  and  it  continues  so  until  the  patient  has 
recovered  from  the  disease  and  has  ceased  to  desqua- 
mate or  shed  scabs.  As  showing,  however,  that  it  is 
much  more  contagious  in  its  early  than  in  its  late  stages, 
may  be  cited  the  fact  that  the  writer  was  able  to  infect 


266       THE  PREVENTION  OF  EPIDEMICS 

monkeys  with  the  vesicle  contents  gathered  from  early 
skin  lesions,  never  with  the  scabs  or  late  products  of 
lesions  from  the  same  case.  The  monkey  is,  of  course, 
naturally  much  less  susceptible  to  smallpox  than  is  man. 
The  same  experiments  seemed  to  indicate  that  for  mon- 
keys and  in  the  Philippines  the  contagium  is  evanes- 
cent. However,  it  is  reputed  to  be  very  persistent  and 
to  cling  for  long  periods  to  infected  places  or  things. 
Varioloid  is  a  mild  form  of  smallpox,  usually  seen  only 
in  persons  who  have  been  vaccinated.  It  may  give  rise 
to  virulent  forms  of  the  disease  if  transmitted  to  more 
susceptible  persons. 

ChicJcenpox  is  probably  air-borne  from  its  onset  and 
for  three  days  thereafter. 

Scarlet  fever  is  contagious  early,  possibly  more  so 
when  the  fever  is  highest,  and  may  continue  so  after 
the  subsidence  of  all  fever  and  for  some  weeks  after 
the  disease  has  apparently  ended. 

Measles  is  more  contagious  than  smallpox  or  scarlet 
fever,  but  fortunately  the  period  during  which  it  is  so 
is  relatively  short.  The  contagiousness  is  most  marked 
during  the  period  of  onset  and  probably  does  not  ordi- 
narily last  beyond  the  second  or  third  day  of  the  erup- 
tion. The  virus  is  more  evanescent  than  that  of  scar- 
latina and  neither  places  nor  things  retain  it  long. 

The  contagium  of  German  measles  is  probably  like 
that  of  measles,  active  for  a  short  time,  but  not  per- 
sistent. 

Mumps  is  contagious  for  about  two  weeks,  or  a  little 
more,  from  the  time  of  its  onset. 

WTiooping-cough  is  probably  contagious  during  the 
entire  period  of  its  existence,  including  the  early  stage 
before  the  development  of  the  whoop. 


RESPIRATORY  TRACT  INFECTION        267 

Influenza^  likewise,  is  probably  contagious  from  the 
onset.  It  often  passes  into  a  chronic  stage,  wherein  the 
active  symptoms  have  subsided,  but  a  slight  cough  or 
some  similar  reminder  persists.  As  the  bacilli  remain 
and  may  be  expelled  by  the  cough,  there  is  reason  to 
think  that  such  cases  may  remain  sources  of  infection 
for  indefinite  periods. 

Cerebrospinal  meningitis  being  due  to  an  organism 
that  may  be  found  in  healthy  noses  and  throats,  but 
one  which  possesses  only  feeble  resisting  powers,  it  is 
impossible  to  say  how  long  it  may  be  contagious.  The 
degree  of  contagiousness  is  not  high. 

The  same  is  true  of  infantile  paralysis. 

Diphtheria  is  contagious  from  its  onset  until  such 
time  as  the  bacilli  have  disappeared  from  the  breathing 
passages,  a  period  exceeding  the  apparent  duration  of 
the  disease  by  days,  weeks,  or  months.  Different  strains 
of  the  organisms  present  decided  differences  of  viru- 
lence, and  this  partly  accounts  for  the  varying  grades 
of  severity  shown  by  epidemics.  The  virus  attaches  it- 
self to  the  clothing,  the  bedding,  and  the  room  in  which 
the  patient  has  lived,  and  has  in  many  instances  dis- 
played great  tenacity. 

Tonsillitis  is  an  inflammation  of  the  tonsils  due  to 
any  cause.  It  may,  therefore,  be  diphtheritic,  but  as 
generally  used  and  as  intended  here,  the  term  signifies 
a  tonsillar  inflammation  due  to  other  organisms  than 
that  of  diphtheria,  and  applies  to  the  common  "  sore- 
throat  "  of  winter-time.  Though  neither  so  dangerous 
nor  so  highly  contagious  as  diphtheria,  it  occasions 
much  discomfort  and  may  spread  through  a  barracks 
to  a  considerable  extent,  especially  if  the  ventilation 
is  poor.    Septic  sore-throat  due  to  milk  has  been  dis- 


268       THE  PREVENTION  OF  EPIDEMICS 

cussed.  It  differs  from  ordinary  tonsillitis  in  its  greater 
severity  and  its  greater  tendency  to  spread  to  other 
structures  and  to  infect  the  blood-stream  and  the  lym- 
phatics. 

Prevention  and  Control 

The  measures  of  control  are  general  and  special. 
The  former  include  all  such  measures  of  hygiene,  clean- 
liness, housing,  heating,  clothing,  and  so  forth  as  tend 
to  lessen  the  dangers  of  crowding,  contact  with  the  sick, 
poor  ventilation,  and  bodily  depression. 

Ventilation  should  at  all  times  be  abundant,  and  it 

should  be  superabundant  in  the  neighborhood  of  the 

sick,  as  it  not  only  promotes  comfort  and 

health,  but  dilutes   the   poison    or  conta- 

gium,  and  so  reduces  the  dose  of  it  that 

those  in  the  neighborhood  may  inhale. 

Water  is  of  only  minor  importance  in  the  diffusion 

of  these  diseases,  but  the  supply  should  be  good  and 

special  care  should  be  used  in  disposing  of  that  which 

has  been  used  in  washing  the  sick  or  their  effects.  It 

should  be  disinfected  by  chemicals  or  heat. 

The  common  drinking  cup  is  a  source  of  danger  in 
barracks  or  in  camp,  and  should  be  abolished  in  favor 
of  individual  cups  or  of  bubbling  fountains  that  cannot 
be  contaminated  by  ordinary  usage  in  drinking. 

I^oods^  other  than  milk,  are  seldom  responsible  for 
the  spread  of  the  diseases  considered ;  but  food  that 
has  been  in  contact  with  the  sick  should  be  carefully 
disposed  of.  The  diphtheria  bacillus,  for  instance,  might 
grow  on  meat,  bread,  potatoes,  or  other  food-articles. 

Persons  having  any  of  these  diseases  should  be  ex- 
cluded from  kitchens,  dining-rooms,  and  all  co^atact 


RESPIRATORY  TRACT  INFECTION         269 

with  any  food  except  that  for  their  own  use  and  con- 
sumption. Supplies  from  bakeries,  meat-shops,  or  other 
food-distributing  places  that  harbor  persons  sick  of 
these  diseases,  are  best  avoided.  It  is  conceivable  that 
they  may  occasionally  be  transmitted  by  means  of  food 
that  has  been  exposed  for  sale  in  places  where  it  might 
be  contaminated  by  infected  dust  or  by  droplets  of  spit 
expelled  by  coughing  persons. 

Milk  is  particularly  dangerous  as  a  means  of  dis- 
semination of  scarlet  fever,  sore-throat,  and  diphtheria, 
and  it  may  possibly  act  in  a  similar  capacity  for  others 
of  these  diseases.  It  is  certainly  the  part  of  wisdom  to 
exclude  persons  having,  or  recovering  from,  or  in  con- 
tact with,  any  of  these  diseases,  from  handling  milk 
intended  for  the  use  of  others.  In  case  of  epidemic  the 
milk-supply  should  be  investigated,  and  steps  be  taken 
to  prevent  infection  through  it.  Pasteurization  or  boil- 
ing will  make  the  milk  safe  if  it  is  protected  from  sub- 
sequent contamination. 

Vermin  should  be  guarded  against  as  possible  dis- 
seminators, as  in  measles,  scarlet  fever,  smallpox,  and 
occasionally  some  of  the  other  diseases  considered,  the 
circulating  blood  may  be  found  infective.  Smallpox 
has  been  attributed  to  flea  transmission,  though  the 
evidence  has  not  been  such  as  to  cause  the  acceptance 
of  the  idea  by  many.  Still,  it  is  not  at  all  impossible 
that  this  disease  may  at  some  time  be  found  to  be  in- 
sect-borne. Biting  flies  are  also  said  to  carry  infantile 
paralysis,  and  the  hypothesis  is  entitled  to  much  respect 
because  of  the  support  found  for  it  in  experiments  at 
Harvard  and  in  the  epidemiological  studies  published 
by  the  Massachusetts  State  Board  of  Health. 

It  is  obvious  that  houae-fliea  might  become  polluted 


270       THE  PREVENTION   OF  EPIDEMICS 

from  eating  or  walking  over  infective  excretions  and 
convey  the  germs  to  other  persons  or  to  food-articles. 

Animals,  such  as  dogs,  cats,  and  other  pets,  should  be 
excluded  from  access  to  the  sick  for  reasons  already 
set  forth. 

Of  special  measures  of  protection  against  these  dis- 
eases the  following  are  probably  most  important :  — 

Early  diagnosis  is  absolutely  essential  for  the  con- 
trol of  most  of  them,  and  is  helpful  in  all.  Measles  is 
highly  contagious  before  the  eruption  ap- 
^  pears,  and  may  be  widely  spread  by  per- 

°  '  sons  appai*ently  suffering  from  "colds." 
All  suspicious  cases  should  therefore  be  re- 
ported to  the  surgeon  for  examination  as  soon  as  any 
symptoms  present  themselves.  As  stated  before,  com- 
pany officers  should  encourage  their  men  to  go  on  sick 
report  at  the  first  appearance  of  disease. 

Persons  in  contact  with  diphtheria  should  be  exam- 
ined to  see  if  they  are  carrying  the  germ  in  their  throats 
or  noses. 

Notification  of  cases  is  the  next  step  in  control.  It 
follows  diagnosis  naturally  in  the  case  of  soldiers  re- 
porting  to  the  surgeon ;  but  occasionally 
officers  or  their  families,  or  more  rarely  en- 
listed men,  consult  civilian  physicians.  In 
such  instances  the  presence  of  contagious  disease  may 
not  be  notified  and  may  escape  official  recognition,  with 
the  consequence  that  preventive  measures  may  not  be 
adopted.  Line  officers,  enlisted  men,  and  civilian  phy- 
sicians, all  should  realize  that  the  highest  function  of 
the  medical  officer  is  the  prevention  of  disease,  and  that 
they  are  preventing  his  performance  of  it,  as  well  as 
violating  orders,  when  they  do  not  promptly  report  to 


RESPIRATORY  TRACT  INFECTION         271 

him  any  cases  of  contagious  disease  in  the  post  with 
which  they  may  be  concerned.  Unless  agreeing  to  act 
thus  fairly,  civilian  physicians  should  not  be  allowed 
to  practice  on  a  military  reservation,  and  they  cannot 
properly  do  so ;  and  officers  and  men  who  through  care- 
lessness or  design  are  responsible  for  the  presence  of 
such  diseases  on  the  post  being  unknown,  should  be 
punished. 

Notification  of  the  presence  of  any  of  the  diseases 
in  this  group  should  at  once  lead  to  an  investigation  of 
its  source,  with  the  object  of  removing  this     m^ar' 
if  possible.  The  nature  of  the  investigation     -, 
will  be  indicated  by  what  has  been  said 
as  to  methods  of  infection  and  incubation  periods. 

The  sick  should  be  isolated  as  soon  as  the  diagnosis 
is  made  or  suspected.  The  character  and  duration  of 
the  isolation  will  vary  with  the  disease.    It  . 

should  in  all  cases  be  sufficiently  strict  to 
prevent  all  unnecessary   contact  with   the   sick,  and 
should  last  until  the  dangerous  period  is  safely  past. 

There  can  now  be  little  doubt  that  much  of  the  benefit 
that  results  from  isolation  is  due  to  lessened  oppor- 
tunities for  contact  with  the  patient  or  his  secretions. 
Much  therefore  depends  on  having  the  nurse  isolated 
also,  or  having  him  so  thoroughly  drilled  in  freeing 
his  person  from  the  germs  and  in  avoiding  contact 
with  them  as  to  reduce  the  chances  of  mediate  contact 
through  him  to  a  minimum. 

Smallpox  should  be  isolated  at  some  distance  from 
dwelling  or  gathering  places,  even  at  the  expense  of 
some  inconvenience.  In  military  life  tents  make  suit- 
able isolation  hospitals  unless  the  weather  is  unusually 
severe.  The  possibility  of  apparently  well  persons  acting 


272       THE  PREVENTION  OF  EPIDEMICS 

as  carriers  must  be  borne  in  mind.  Diphtheria  patients 
and  their  attendants  must  not  be  released  from  isolation 
until  their  respiratory  passages  are  free  from  germs, 
scarlet  fever  patients  until  all  discharges  from  the  throat, 
nose,  and  ears  have  ceased,  and  the  individual  has  been 
well  a  month  or  more.  In  all  instances  the  character 
and  duration  of  isolation  are  matters  to  be  determined 
by  the  medical  officer.  Men  breaking  isolation  bounds 
should  be  severely  punished,  as  they  may  expose  their 
comrades  to  grave  danger.  Persons  known  to  be  ex- 
posed to  these  diseases  may  properly  be  isolated,  or  at 
least  kept  under  stnct  surveillance,  for  a  time  equal  to 
the  maximum  period  of  incubation.  Those  suspected  of 
having  any  of  them  should  be  isolated  until  the  diag- 
nosis is  definitely  established  in  the  negative. 

Everything  that  has  been  contaminated  by  the  use, 
_ .   .    ,  association,  or  proximity  of  the  sick  should 

^  be  disinfected  before  being  allowed  to  pass 

non  •    i.    -i.      J-  1 

again  to  its  ordinary  place. 

The  sick  person  and  his  attendants  should  be  well 
bathed  before  coming  out  of  isolation,  and  the  bath 
should  be  followed  in  the  case  of  smallpox,  scarlet  fever, 
or  diphtheria  by  a  washing  with  an  antiseptic  solution. 
Clean  clothing  should  then  be  put  on.  Animals  that  have 
been  in  the  sick-room  should  be  similarly  treated.  Cloth- 
ing  and  bedding  may  be  disinfected  by  boiling,  steam- 
ing, soaking  in  an  antiseptic  solution,  or  with  formalin. 
The  last  named  method  is  less  reliable  than  the  others. 
Houses^  and  especially  the  room  occupied  by  the  sick 
person,  and  its  furniture,  should  be  scrubbed,  sunned, 
and  aired.  The  belief  that  fumigation  and  other  house 
disinfection  is  unnecessary  is  growing,  and  experience 
based  on  the  belief  indicates  that  those  measures  may 


RESPIRATORY  TRACT  INFECTION       273 

usually  be  ignored  with  safety.  Sunlight,  cleanliness, 
time,  drying,  and  fresh  air  do  the  work.  Utensils  may 
be  boiled,  steamed,  or  washed  in  antiseptics,  while  letters, 
books,  and  similar  articles  may  be  sterilized  with  forma- 
lin if  they  have  been  in  contact  with  the  patient.  The 
discharges  of  the  patient  should  be  mixed  with  formalin 
or  carbolic  solution  and  allowed  to  stand  an  hour  before 
being  thrown  out.  The  sputum  should  receivie  particular 
care,  as  it  carries  the  contagium  of  most  if  not  all  of 
these  diseases.  The  patient  should  only  spit  into  vessels 
containing  antiseptic  solution,  and  even  then  it  is  safer 
if  the  spit  be  burned.  Handkerchiefs  and  cloths  used 
to  wipe  the  mouth  or  nose  should  be  burned  or  boiled. 
The  use  of  paper  handkerchiefs  by  all  sick  persons 
would  be  a  wise  and  useful  measure.  Surgical  dressings 
should  be  burned. 

The  most   efficient   measure   for  the  prevention  of 
smallpox  is  the  induction  of  acquired  immunity  through 
vaccination.  The  government  very  properly    _    ,        , 
demands  that  every  recruit  shall  be  vac-    _ 
cinuted,   but   occasionally  the   inoculation       . 
does  not  "  take  "  on  a  susceptible  man,  and 
through  a  combination  of  circumstances  he  may  escape 
its  repetition.    In  civil  life  there  is  a  considerable  agi- 
tation against  the  use  of  vaccination,  the  agitators  alleg- 
ing that  it  does  not  protect  against  smallpox,  that  it  is 
an  invasion  of  personal  rights,  and  indulging  in  several 
other  incorrect  statements.  It  is  not  purposed  to  discuss 
the  matter  at  length  here,  but  it  may  be  stated  that  the 
evidence  that  vaccination  does  protect  against  smallpox 
is  overwhelming,  and  a  belief  to  the  contrary,  however 
honest  and  earnest  it  may  be,  cannot  justify  any  one  in 
endangering  the  efficiency  and  safety  of  an  army  by  its 


274       THE  PREVENTION  OF  EPIDEMICS 

neglect,  any  more  than  can  a  belief  that  every  man  is 
born  with  a  right  to  smallpox  if  he  wants  it.  Any  oflBcer 
or  man  who  in  any  way  interferes  with  the  complete  and 
thorough  vaccination  of  the  army  makes  a  great  mis- 
take and  commits  a  grave  offense. 

The  spread  of  diphtheria  may  be  partly  controlled  by 
the  use  of  antitoxin.  This  may  be  and  is  very  gener- 
ally used  in  the  treatment  of  those  sick  with  the  disease, 
but  it  is  also  of  value  when  used  as  a  preventive  mea- 
sure. It  is  then  injected  in  relatively  small  doses  into 
persons  brought  into  contact  with  the  disease.  So  used, 
it  greatly  lessens  the  liability  to  infection,  and  to  se- 
verity in  case  infection  does  occur.  However,  because 
of  the  possibility  of  rendering  the  individual  suscep- 
tible to  anaphylaxis  in  case  of  necessity  for  using  the 
serum  at  a  much  later  date,  it  is  preferable  to  prevent 
diphtheria  by  other  means,  if  possible.  Vaccinations 
and  the  use  of  preventive  injections  of  antitoxin  have 
not  yet  proved  of  value  in  protecting  from  the  other 
members  of  this  group,  though  they  may  later  be  found 
applicable  in  some  instances. 


CHAPTER  XIV 

INSECT-BORNE    DISEASES 

The  principal  human  diseases  now  known  to  be  insect- 
borne  are  malaria,  yellow  fever,  filariasis,  and  dengue, 
carried  by  mosquitoes  ;  sleeping  sickness,  carried  by 
tsetse  flies ;  plague,  carried  by  fleas ;  spotted  fever  in 
Montana  and  the  relapsing  fever  of  central  Africa, 
carried  by  ticks ;  typhus  fever  and  relapsing  fever  of 
most  parts  of  the  world,  carried  by  lice  ;  river  fever  or 
tsutsugainushi  disease  of  Japan,  carried  by  a  small  red 
mite ;  sand-fly  fever  or  three-day  fever  of  the  Balkans 
and  other  parts,  carried  by  sand-flies ;  Chagas'  disease 
in  Brazil,  carried  by  the  "barbiero,"  Lamus  megistus; 
and  kala-azar,  which  is  almost  certainly  insect-borne, 
though  it  is  not  yet  quite  determined  what  insect  is  the 
carrier,  the  bedbug  being  accused  in  India  and  the  flea 
in  the  Mediterranean  countries.  Leprosy,  smallpox,  pol- 
iomyelitis, pellagra,  and  a  number  of  other  human  dis- 
eases have  been  attributed  by  various  writers  to  insect 
carriage,  but  the  proof  adduced  has  not  been  such  as  to 
carry  conviction  to  the  majority  of  workers.  Very  many 
diseases  of  animals  are  insect-borne,  among  them  some 
of  the  most  widely  spreading  and  fatal.  Both  animals 
and  man  are  subject  to  infestation  with  the  larvae  of 
flies  that  deposit  their  eggs  on  the  mucous  membranes, 
under  the  skin,  or  in  wounds  of  their  hosts.  The  screw 
worm  is  an  example  of  this. 

The   diseases    named    above   will  be  considered   in 
groups  made  to  conform  to  the  insects  carrying  them. 


276       THE  PREVENTION  OF  EPIDEMICS 

MOSQUITO-BORNE   DISEASES 

The  most  widespread  and  common  of  these  is  mala- 
ria. It  prevails  in  most  tropical  and  sub-tropical  coun- 
-j  ,  .  tries,  and  in  some  of  them  it  produces  a 
great  mortality,  while  it  causes  much  suf- 
fering, weakness,  and  loss  of  time,  even  where  it  is 
less  fatal  It  is  an  important  cause  of  sickness  in  our 
army  in  many  parts  of  our  own  country,  as  well  as  in 
Cuba,  Porto  Kico,  the  Philippines,  and  the  Isthmus  of 
Panama. 

Since  the  beginning  of  the  Spanish-American  War 
the  knowledge  of  the  methods  of  control  of  this  dis- 
ease has  increased  so  rapidly  that  it  has  now  become 
possible  for  us  to  make  healthy  communities  out  of 
places  formerly  notorious  for  the  certainty  and  speed 
with  which  newcomers  sickened  or  died  from  malaria, 
though  it  must  be  admitted  that  the  accomplishment  of 
such  a  result  is  both  difficult  and  expensive. 

As  stated  in  a  previous  chapter,  there  are  at  least  three 
varieties  of  this  disease  which  differ  because  the  para- 
sites causing  them  do  so,  and  which  manifest  themselves 
in  paroxysms  of  chill,  fever,  and  sweat,  that  come  at 
twenty-four,  forty-eight,  or  seventy-two-hour  intervals. 
This  regularity  of  manifestation  is  only  shown,  how- 
ever, in  cases  of  uncomplicated  single  infections.  Owing 
to  multiple  infections  or  complicating  circumstances, 
any  one  of  these  types  of  malaria  may  show  extreme 
irregularity  and  may  be  mistaken  for  other  diseases, 
the  diagnosis  being  made  possible  only  by  examination 
of  the  blood,  and,  at  times,  with  great  difficulty.  The 
fever  may  be  continuous  and  the  general  symptoms 
such  as  to  make  the  disease  appear  much  like  typhoid. 


INSECT-BORNE   DISEASES  277 

Or  it  may  be  manifested  as  a  neuralgia,  as  a  sudden 
attack  resembling  apoplexy,  as  anaemia,  or  in  other 
obscure  ways.  This  disease  also  exhibits  periods  of  la- 
tency, during  which  the  parasite  is  present  in  the  body, 
but  in  such  numbers  or  under  such  control  by  the  body 
forces,  that  no  signs  or  symptoms  are  present.  When, 
however,  the  vital  forces  are  reduced,  as  by  exposure, 
overwork,  alcoholism,  or  other  disease,  the  parasites 
gain  the  ascendency  and  the  disease  may  manifest 
itself  in  a  severe  manner.  Many  natives  of  highly  ma- 
larious regions  may  be  partly  immune  and  show  no 
symptoms  even  when  harboring  very  severe  infections. 

Whatever  the  character  of  its  manifestation,  how- 
ever, the  infection  is  always  received  through  the  bite 
of  a  mosquito.  Many  officers  from  time  to  time  express 
views  to  the  contrary,  usually  basing  them  on  their  own 
faulty  observations.  Occasionally  there  is  reason  to 
suspect  that  the  views  are  exploited  to  account  for  the 
presence  of  malaria  when  the  efforts  to  prevent  mos- 
quito-transmission entail  an  inconvenient  amount  of 
trouble.  The  fact  is  that  malaria  has  been  investigated 
with  a  thoroughness  that  has  been  accorded  to  few  other 
diseases,  and  the  method  of  mosquito-transmission  has 
been  abundantly  proved,  and  no  other  appears  even 
probable.  "  If,  after  they  have  imbibed  malarial  blood, 
certain  species  of  mosquitoes  be  dissected  at  serial  in- 
tervals, the  evolution  of  the  malaria  parasite  can  be 
followed  in  their  tissues,  until,  finally,  the  germs  of  the 
parasite  can  be  tracked  into  the  cells  and  secretions 
of  the  salivary  glands  of  the  insect. 

"  If  after  a  week,  or  thereabouts,  a  similarly  fed  mos- 
quito bites  a  hitherto  uninfected  man,  in  many  instances, 
after  a  few  days,  that  man  will  exhibit  the  clinical 


278       THE  PREVENTION  OF  EPIDEMICS 

phenomena  of  malaria  infection  and  the  characteristic 
parasite  in  his  blood. 

"  A  non-immune,  if  effectually  protected  against  mos- 
quito bite,  will  not  contract  malarial  disease,  however 
long  he  may  live  in  highly  malarious  localities. 

"  Most  observers  are  now  of  the  opinion  that  the  ma- 
laria parasite,  under  natural  conditions,  can  be  acquired 
by  man  only  through  the  bite  of  the  mosquito  ;  that  the 
mosquito  can  acquire  the  parasite  only  by  ingesting 
the  blood  of  a  malaria- infected  man,  or  possibly  other 
mammal ;  that  there  is  no  extra-corporeal  life  other  than 
that  described ;  that  there  is  no  authentic  instance  of 
malaria  being  acquired  in  uninhabited  places ;  that  in 
the  case  of  malaria  in  connection  with  soil  disturbances, 
it  depends  on  the  creation  during  digging  operation  of 
puddles  of  water  in  which  mosquitoes  breed ;  and  that 
its  epidemic  occurrence  under  these  circumstances  is 
owing  to  unhygienic  conditions  such  as  usually  prevail 
when  large  bodies  of  men,  some  of  whom  may  bring  the 
infection  with  them,  are  brought  together  on  public 
works  attended  with  extensive  earth-cutting,  as  in  rail- 
way, road,  or  canal-making." 

Several  species  of  mosquitoes  are  capable  of  trans- 
mitting the  disease,  but  they  all,  so  far  as  now  known, 
belong  to  the  sub-family  Anophelinoe.  The 
-_  .  ,  features  by  means  of  which  these  various 
.  species  may  be  identified  cannot  be  dis- 
^  cussed  here,  and  positive  identification  is  a 

labor  necessitating  some  time  and  effort  even  on  the 
part  of  the  specialist ;  but  a  popular  rough  method  of 
identifying  anopheline  mosquitoes  in  general  is  that 
the  adults,  when  at  rest,  stand  with  their  bodies  almost 
or  quite  at  a  right  angle  with  the  surface  on  which  they 


INSECT-BORNE  DISEASES  279 

are  resting,  while  commoner  species  rest  with  the  body 
more  nearly  parallel  to  the  supporting  surface.  The 
larvae,  or  "  wigglers,"  of  the  former  class,  on  the  other 
hand,  rest  with  their  bodies  like  floating  sticks,  parallel 
to  the  surface  of  the  water  in  which  they  are  swim- 
ming. The  more  common  varieties  have  theirs  more 
nearly  at  a  right  angle  to  it.  These  mosquitoes  bite 
principally  at  night. 

Yellow  fever  is  an  acute  and  very  fatal  disease  that 
occurs  principally  in  tropical  and  sub-tropical  America, 
though  epidemics  also  occur  on  the  west     ■«»■  ii 
coast  of  Africa,  where  the  disease  was  pos-    _, 
sibly  introduced  by  slave-traders.    It  has 
appeared  in  epidemic  form  as  far  north  as  Philadelphia. 

Until  after  the  American  occupation  of  Cuba  and 
the  subsequent  work  of  the  board  of  army  medical  offi- 
cers, under  the  presidency  of  Major  Walter    -lur  ^.i,    j 
Reed,   the   method   of   infection  was   un-       ,  _^ 

known,  and  water,  contact,  fomites,  poor    .     . 

police,  and  atmospheric  conditions  were  all 
credited  as  means.  That  Board  cleaned  up  all  obscure 
questions  as  to  the  manner  of  transmission,  and  estab- 
lished beyond  dispute  the  fact  that  yellow  fever  is  trans- 
mitted by  the  bite  of  infected  mosquitoes  of  the  species 
Stegomyiafasciata.^  It  cannot  be  transmitted  by  water, 
food,  fomites,  air,  or  contact,  nor  is  its  spread  influenced 
by  poor  policing,  except  as  the  latter  promotes  the  breed- 
ing of  mosquitoes.  The  beautiful  reasoning  and  experi- 
ments which  served  to  establish  our  knowledge  of  the 
means  of  transmission  also  cleared  up  many  hitherto 
obscure  points  about  the  disease,  and,  better  still,  led 
to  the  use  of  anti-mosquito  measures  that  resulted  in  its 
^  Since  known  as  Stegomyia  calopus  and  as  ^de$  calopus. 


280       THE   PREVENTION   OF  EPIDEMICS 

eradication  from  Havana,  and  later  from  New  Orleans, 
the  Canal  Zone,  and  other  regions.  This  constituted  one 
of  the  greatest  sanitary  advances  that  the  world  has  ever 
seen,  one  making  possible  the  rejuvenation  of  Cuba, 
the  construction  of  the  Panama  Canal,  and,  it  is  hoped, 
the  civilization  and  development  of  all  tropical  America ; 
and  it  is  well  that  army  officers  should  keep  in  mind 
that  all  of  these  things  were  made  possible  by  the  fact 
that  there  happened  to  be  in  command,  in  Havana,  a 
line  officer  who  had  a  knowledge  and  an  appreciation 
of  the  importance  of  military  hygiene. 

The  Board  of  which  Major  Reed  was  the  head  showed 
that  contact,  fecal  contamination,  handling  of  fomites, 
breathing  the  close  air  breathed  by  yellow-fever  pa- 
tients in  poorly  ventilated  places,  and  all  such  things, 
were  incapable  of  transmitting  the   disease,  but  that 
the  bite  of  some  infected  mosquitoes  would  be  followed 
by  the  fever  in  from  three  to  five  days,  or  occasionally 
longer.    This   is  the  ordinary  incubation- 
period  in  man,  and  accounts  for  the  fact 
f   ,  that  non-immunes  may  develop  the  disease 

so  short  a  time  after  arrival  in  places  where 
the  disease  prevails.  But  there  is  also  an 
incubation-period  in  the  mosquito,  as  shown  by  the  fact 
that  it  cannot  transmit  the  disease  until  twelve  days  after 
it  has  imbibed  the  infection  with  the  blood  of  a  sick  per- 
son. This  accounts  for  the  half-month  elapsing  between 
the  arrival  in  an  uninfected  place  of  a  case  of  yellow 
fever  and  the  appearance  of  the  first  case  of  the  subse- 
quent epidemic.  This  double  incubation  period,  three 
days  for  a  case  in  an  already  infected  district,  and  fifteen 
or  more  days  for  secondary  cases  in  previously  non-in- 
fected districts,  is  thus  clearly  explained. 


INSECT-BORNE   DISEASES  281 

Not  nearly  all  mosquitoes  biting  yellow-fever  patients 
are  capable  of  transmitting  the  disease  even  after  twelve 
days,  and  the  Board  showed  that  this  was  because  of 
the  short  period  during  which  the  yellow-fever  patient 
is  infectious.  Unless  it  bites  him  during  his  first  three 
days  of  sickness,  the  insect  obtains  no  infection  and  can 
transmit  none.  It  was  also  demonstrated  that  the  cause 
of  the  disease  is  in  the  blood,  that  it  passes  through 
very  fine  filters,  and  is  probably  too  small  to  be  seen  with 
our  microscopes,  and  that  it  may  persist  in  infected 
mosquitoes  for  weeks  or  months. 

"  These  experiments  fully  explain,  Ist,  the  impunity 
with  which  a  yellow-fever  patient  can  be  visited  by  a 
non-immune  if  outside  the  endemic  area :  the  mosquitoes 
in  the  vicinity  are  not  infective.  2d,  the  danger  of 
visiting  the  endemic  area,  especially  at  night :  the  mos- 
quitoes there  are  infective  and  active.  3d,  tlie  discrep- 
ancy between  the  incubation-period,  three  to  five  days, 
of  the  disease,  and  the  incubation-period,  fifteen  days 
and  over,  of  an  epidemic:  the  necessary  evolution  of 
the  germ  in  the  mosquitoes  infected  by  the  original 
introducing  patient  demanding  the  space  of  time  indi- 
cated by  the  difference  between  these  two  periods.  4th, 
the  clinging  of  yellow-fever  infection  to  ships,  buildings, 
and  localities :  the  persistence  of  the  germ  in  infected 
mosquitoes  which  are  known  to  be  capable  of  surviving 
for  five  months,  and  probably  longer,  after  feeding  on 
blood.  6th,  the  high  atmospheric  temperature  required 
for  epidemic  extension  of  yellow  fever :  such  tempera- 
ture favors  the  activities  and  propagation  of  the  mos- 
quito, and  is  probably  necessary  for  the  evolution  of  the 
germ  also  in  the  mosquito." 

The  mosquito  that  transmits  yellow  fever  is  a  very 


282       THE  PREVENTION   OF  EPIDEMICS 

common  one  in  all  those  parts  of  America  that  show 
_,  the  disease.    A  closely  allied  or  identical 

_  .-  speciesis  abundant  in  the  Philippine  Islands. 

_,  Whether  or  not  this  Philippine  variety  is 

-_  capable  of  transmitting  the  disease  is  not 

positively  known,  but  if  it  can  do  so  the  in- 
troduction of  the  disease  into  those  islands, 
a  thing  quite  possible  after  the  opening  of  the  Panama 
Canal,  might  prove  a  disaster  of  the  first  magnitude 
and  a  great  addition  to  their  already  numerous  afflic- 
tions. However,  yellow  fever  is  so  thoroughly  under 
control  in  Panama  and  other  points  from  which  ships 
are  apt  to  go  to  the  East,  and  the  method  of  its  control 
is  so  well  understood  and  the  journey  so  long,  that  the 
chances  of  such  introduction  are  considered  remote. 

The  mosquito  concerned  is  a  small  black  one,  with 
white  or  silvery  lines  and  bands  on  the  thorax  and  legs. 
There  is  a  peculiar  lyre-shaped  figure  on  the  back  of  the 
thorax  which,  together  with  the  white  bands  on  its  legs, 
makes  a  rough  diagnosis  of  species  possible.  The  insects 
particularly  prefer  low-lying  shores,  but  may  be  found 
in  other  places.  They  are  essentially  house-lovers,  are 
active  biters,  silent  and  very  quick,  so  that  they  are  harder 
to  catch  than  other  varieties.  They  breed  in  small  ar- 
tificial collections  of  water,  such  as  barrels,  puddles, 
cisterns,  and  partially  filled  tin  cans.  "  The  nature  of 
the  water  appears  to  be  a  matter  of  indifference :  it  is 
found  equally  in  rain  or  waste  water,  but  more  frequently 
in  water  discolored  by  decaying  vegetable  matter." 

Dengue  is  a  disease  of  very  low  fatality,  but  one  which 

—.  may  occasion  much  suffering  and  anxiety, 

and  which  sometimes  occurs  in  widespread 

epidemics.  The  disease  causes,  on  an  average,  about 


INSECT-BORNE  DISEASES  283 

one  week  of  absence  from  duty,  and  if  the  epidemic 
involves  thirty  or  forty  per  cent  of  a  command,  a  not 
unusual  figure,  the  strength  of  the  force  will  be  much 
impaired.  It  prevails  in  the  West  Indies,  the  Philip- 
pines, our  Southern  States,  and  in  most  other  parts  of 
the  tropical  and  subtropical  world.  Like  yellow  fever, 
it  is  a  disease  of  hot  weather  and  low  lands,  that  has 
prevailed  as  far  north  as  Philadelphia  in  summer- 
time. It  is  transmitted  by  a  very  common  variety  of 
mosquito,  Culex  Jatigans,  and  possibly  by  other  varie- 
ties, but  not  by  contact,  food,  drink,  air,  or  fomites. 
The  incubation-period  is  from  three  to  seven  days, 
usually  about  four ;  the  causative  organism  is  contained 
in  the  blood,  passes  through  fine  filters,  and  is  probably 
too  small  to  be  seen  with  the  microscope.  The  disease 
resembles  yellow  fever  in  man}^  respects,  and  has  often 
been  confused  with  it  in  America. 

Filariasis  is  infestation  with  any  one  of  several  varie- 
ties of  filaria,  or  hair-worm,  whose  young  circulate  in 
the  blood.  It  is  thought  to  be  related  to  _,..  . 
elephantiasis,  but  was  suffit;iently  discussed 
in  a  preceding  chapter.  The  parasites  are  introduced 
through  the  bites  of  mosquitoes,  one  of  the  most  com- 
mon and  widespread  species,  Culex  fatigans,  acting 
as  a  carrier  for  at  least  two  varieties.  The  insect  bites 
both  by  day  and  by  night. 

The  prevention  of  these  mosquito-borne  diseases  rests 
entirely  upon  our  ability  to  protect  against  the  bites  of 
infected  insects,  except  in  the  case  of  mala- 
ria,  in  which  we  can  derive  aid  from  the 
administration  of  quinine.  Our  success  then  _,     ^ 
depends  on  anti-mosquito  measures,  and  it 
is  necessary  to  discuss  these  briefly.  Mosquitoes  breed 


284         THE  PREVENTION  OF  EPIDEMICS 

only  in  water,  the  young  being  as  much  dependent  on 
that  fluid  as  are  fish  or  tadpoles.  The  Culex^  or  com- 
mon mosquito,  which  transmits  dengue  and  filaria,  and 
the  Stegomyia^  or  striped  mosquito,  which  carries  yellow 
fever,  generally  breed  in  vessels  of  water,  cisterns,  or 
drains.  The  Anopheles^  or  malarial  mosquitoes,  breed 
"mostly  in  shallow  puddles  on  the  ground,  in  small 
ponds,  in  slow  and  small  runnels  of  water,  in  pools  of 
rain  water,  on  rocks,  on  the  margin  of  slow-running 
streams,  and  sometimes,  but  rarely,  in  vessels  of  water." 

It  must  be  borne  in  mind,  though,  that  the  Stego- 
myia  is  really  the  only  one  of  the  mosquitoes  known  to 
carry  disease  that  is  so  fixed  in  its  habits  as  to  make 
its  extermination  relatively  easy.  This  mosquito  is 
practically  banished  from  the  Canal  Zone,  though  still 
found  in  the  adjacent  city  of  Panama,  and  in  the  Zone 
very  little  work  is  required  to  keep  free  from  it.  The 
work  against  Culex  and  Anopheles^  however,  is  con- 
stant, hard,  expensive,  almost  endless,  and  distinctly  less 
successful  in  its  results.  These  mosquitoes,  as  repre- 
sented by  their  various  species,  can  manage  to  find  favor- 
able conditions  in  the  Canal  Zone  at  all  times  of  the 
year,  and  in  almost  all  kinds  of  water,  including  a 
mixture  that  contains  a  large  amount  of  sea-water.  In 
fact,  the  largest  and  most  annoying  flights  of  mos- 
quitoes seen  on  the  Zone  have  always  come  from  the 
hydraulic  filling  of  fresh  water  swamps  with  salt  water 
material,  that  is,  with  mud  pumped  from  under  salt 
water.  At  Gatun,  Toro  Point,  Cristobal,  Panama,  and 
other  places  this  has  been  the  case. 

The  larvae  or  wigglers  of  all  kinds  of  mosquitoes  re- 
quire at  least  six  or  seven  days  of  life  in  water  before 
they  can  develop  into  winged  insects,  and  the  time  is 


INSECT-BORNE  DISEASES  285 

usually  longer,  especially  if  the  weather  be  cool  or  con- 
ditions otherwise  unfavorable.  Drying  kills  them  and 
also  destroys  mosquito  eggs.  On  the  other  hand,  natural 
degrees  of  heat  and  cold  do  not  necessarily  destroy  them 
if  they  remain  in  water,  and  in  northern  latitudes  both 
larvae  and  adults  may  survive  several  freezings  during 
a  winter  and  again  become  active  when  warm  weather 
returns.  Usually  only  female  mosquitoes  suck  blood, 
and  they  do  so  because  the  rich  nutriment  hastens  the 
ripening  of  their  eggs,  and  these  are  generally  deposited 
only  after  such  a  meal.  As  the  mosquito  fills  herself  to 
a  degree  that  greatly  increases  her  bulk  and  weight, 
and  makes  flight  laborious  and  slow,  she  usually  seeks 
a  place  near  at  hand  in  which  to  deposit  her  eggs.  Partly 
for  this  reason  it  follows  that  most  infested  houses  or 
localities  breed  their  own  mosquitoes. 

It  has  been  demonstrated  in  the  Canal  Zone  that 
Anopheles  can  and  on  occasion  do  fly  more  than  a  mile 
from  their  place  of  breeding.  The  occasions  for  such 
flights  are,  in  the  writer's  opinion,  limited  to  such  as 
present  the  following  circumstances  ;  a  large  area  where 
the  conditions  for  breeding  are  unusually  favorable, 
such  as  one  of  the  salt  hydraulic  fills  mentioned  above, 
an  enormous  amount  of  breeding  in  such  an  area,  lack 
of  abundant  human  blood  for  food  in  the  neighborhood 
of  the  breeding  place,  the  presence  of  abundance  of 
food  (a  town)  at  a  distance  of  a  mile.  Were  there  an- 
other town  within  two  hundred  yards,  or  a  quarter  or 
a  half  of  a  mile,  the  chances  are  that  the  town  a  mile 
away  would  scarcely  notice  any  change  in  the  number 
of  mosquitoes.  In  fact,  such  has  been  the  experience  at 
several  places  on  the  Isthmus.  The  conditions  favored 
a  big  flight,  but  a  human  barrier  in  the  neighborhood 


286       THE  PREVENTION   OF  EPIDEMICS 

served  to  check  it  and  to  make  the  increase  of  mosqui- 
toes a  merely  local  one.  In  ordinary  sanitary  practice, 
and  not  considering  such  exceptionally  large  and  favor- 
able breeding  places,  the  control  of  all  breeding  within 
four  hundred  yards  of  towns,  posts,  and  houses  serves  to 
make  them  fairly  comfortable  and  safe  places  of  resi- 
dence. But  even  this  much  is  no  small  task  in  the  trop- 
ics. The  Anopheles^  like  the  Stegomyia^  appears  to  be 
a  man-lover,  though,  unlike  it,  not  a  house  breeder. 
Practically  always  breeding  in  the  open,  in  what  might 
be  considered  natural,  though  often  actually  artificial, 
collections  of  water,  and  almost  never  in  cans,  barrels, 
cisterns,  and  like  containers,  it  is  nevertheless  usually 
found  fairly  close  to  human  habitations ;  and  many  lo- 
calities in  the  Canal  Zone  that  formerly,  when  towns 
were  near,  bred  great  numbers  of  Anopheles^  now,  since 
the  areas  in  question  have  been  depopulated,  breed 
almost  none.  "Mosquitoes,  especially  Anopheles,  love 
thick  undergrowth." 

The  facts  above  stated  indicate  the  steps  to  be  taken 
in  warring  against  them,  and  of  these,  destruction  of 

breeding-places  in  or  near  camps,  habita- 
,         tions,  towns,  and  garrisons  is  probably  the 

most  important.  The  measures  designed  to 
°    attain  this  end  are  numerous.  Drainage  by 

ditches  or  by  subsoil  tile,  reclamation  of 
swamp  lands,  opening  fresh  water  or  brackish  swamps 
to  salt  water  tides  so  as  to  convert  them  to  salt  water 
marshes  and  flood  them  daily  with  strong  sea  water, 
i\xejUling  of  pools,  puddles,  hollows,  and  marshes,  the 
building  of  dikes  and  embankments  to  create  lahes  in- 
stead of  marshes  and  to  protect  dry  lands  from  flooding, 
the  clearing  of  the  banks  of  lakes  and  streams  from 


INSECT-BORNE  DISEASES  287 

brush  and  grass  and  cutting  them  steep  and  deep  so 
as  to  permit  and  favor  wave  action^  the  cleaning^ 
straightening^  and  narrowing  of  sti-eams  to  give  them 
a  more  rapid  flow,  are  some  of  the  general  measures 
that  can  be  profitably  employed  in  the  vicinity  of  towu« 
or  of  permanent  garrisons.  Each  of  these  measures 
may  be  very  expensive  as  to  first  cost,  yet  each  may 
prove  a  highly  profitable  investment.  A  few  specific 
instances  may  be  cited  from  the  Canal  Zone.  Drain- 
age by  ditch  and  tile  has  been  used  in  and  about  every 
town  in  the  Zone,  and  has  always  given  good  results  and 
done  away  with  breeding  places.  Opening  fresh  water 
swamps  to  tidal  wash  has  done  away  with  large  areas 
of  breeding  at  Mindi  Island  near  Cristobal.  The  filling 
of  swamps  and  low  lands,  often  done  as  a  mere  matter 
of  convenient  disposal  of  soil,  has  made  dry  many 
former  breeding  places.  Even  the  hydraulic  fills  that 
have  been  mentioned  as  giving  rise  to  excessive  breed- 
ing, only  do  so  for  a  period  of  months,  and  after  they 
have  dried  out  they  may  leave  fine  sites  for  town  exten- 
sion, as  at  Ancon  and  Balboa.  The  building  of  dikes 
and  the  creation  of  lakes  have  done  good  by  deepening 
the  water,  as  mosquitoes  rarely  breed  in  water  more 
than  two  or  three  feet  deep,  and  by  creating  more  favor- 
able conditions  for  fish  and  for  wave  motion,  both  of 
which  destroy  larvas.  A  small  lake  at  Pedro  Miguel, 
which  long  produced  large  numbers  of  mosquitoes  and 
caused  the  expenditure  of  much  money  and  labor  on  its 
treatment,  was  rendered  harmless  and  self-caring  by 
the  expedient  of  cutting  its  banks  at  an  angle  of  one 
or  one  and  a  half  to  a  depth  of  a  foot  and  a  half  above 
and  the  same  below  its  general  level,  and  freeing  them 
of  vegetation.  This  allowed  the  small  fish  and  the  wave 


28S        THE  PREVENTION  OF  EPIDEMICS 

action  to  get  at  and  destroy  the  larvae  that  formerly 
found  shelter  from  both  in  the  vegetation  growing  in 
shallow  water  along  shore.  The  clearing  and  straighten- 
ing of  streams,  "  training  "  them  to  run  rapidly  and 
strongly  and  to  flush  themselves  well,  act  similarly. 
Cleaning  bodies  of  water  of  vegetation  is  at  times  a 
moat  useful  expedient,  as  mosquitoes  breed  in  water- 
liolding  leaves,  such  as  those  of  the  water  "  cabbage  " 
and  the  water  hyacinth,  while  other  vegetation,  such  as 
Para  grass  and  algae,  offer  shelter  wherein  the  larvae 
find  protection  from  fish. 

But  efforts  must  not  be  confined  to  such  large  under- 
takings, because  the  chances  are  that  less  ambitious 
projects,  carried  out  in  or  about  the  dwelling,  may  ac- 
complish almost  as  much  good,  and  it  will  be  manifested 
H)ore  promptly.  Such  local  measures  will  include  the 
filling  of  small  hollows  in  the  yard  or  about  the  house, 
or  cutting  such  outlets  from  them  that  they  will  empty 
quickly  after  rains,  filling  or  preventing  the  form- 
ation of  pockets  or  pools  at  the  outlets  of  drains  or 
under  faucets,  filling,  emptying,  or  obliterating  hoof- 
tracks,  wagon-ruts,  and  similar  small  depressions,  seeing 
that  fire-buckets,  fountains,  drip-pans  under  ice-chests 
and  similar  water  containers  are  emptied  twice  a  week, 
and  alllarvaB  contained  in  them  killed.  Empty  or  partly 
empty  bottles,  boxes,  tin  cans,  tubs,  and  flower-pots  must 
be  removed  or  placed  in  such  positions  or  conditions 
that  they  will  not  catch  and  hold  water.  Useless  joints 
or  sections  of  bamboo  must  be  removed,  and  pieces  that 
are  in  use  or  that  form  parts  of  buildings  should,  if  open, 
he  bored  at  the  lowest  level  of  the  joint  so  as  to  let  all 
water  run  out.  The  water  in  tins  or  saucers  under  table- 
legs  or  elsewhere  as  a  protectioii  from  ants  should  be 


INSECT-BORNE   DISEASES  289 

kept  olean  and  free  from  larvae.  It  would  be  well  to  have 
such  things  filled  with  antiseptic  solution  rather  than 
plain  water.  Sagging  eave-troughs  and  drain-pipes  and 
catch-basins,  that  do  not  empty  promptly,  may  afford 
breeding-places,  and  should  therefore  be  made  right. 
Banana  plants  afford  quite  sufficiently  large  receptacles 
for  breeding  water  at  the  points  where  the  leaves  di- 
verge from  the  main  stalk,  and  trees  may  provide  them 
in  knot-holes.  It  may  be  stated,  however,  that  breed- 
ing in  banana  plants  is  less  common  than  is  generally 
thought.  All  such  places  must  be  investigated  and 
faults  corrected.  Irrigating  ditches  should  run  freely 
and  with  a  good  current  when  in  use,  and  should  drain 
dry  at  other  times.  They  should  not  present  stagnant 
pools  at  any  time.  Thick  underbrush  and  high  grass 
should  be  cut  and  cleared  awa}^  as  it  not  only  shelters 
and  harbors  the  grown  mosquitoes,  but  hides  and  pre- 
serves small  collections  of  water  and  keeps  them  from 
drying.  Cisterns,  shallow  wells,  rain-barrels,  and  other 
large  useful  containers  of  water  should  be  screened  or 
tightly  covered  so  that  mosquitoes  cannot  gain  access 
to  them.  Privies  and  cesspools  should  likewise  be  pro- 
tected by  netting  or  tight  covers,  so  as  to  keep  them 
free  from  the  insects,  and  drain  outlets  should  empty 
on  smootii  rocks,  or  be  otherwise  so  arranged  that  pools 
and  puddles  are  not  formed  by  their  discharge.  Other 
precautions  may  be  necessary  and  the  circumstances 
may  suggest  them.  The  object  to  be  kept  in  mind  is 
the  doing  away  witb  all  stagnant  water. 

Many  of  the  measures  outlined  above,  such  as  drain- 
ing pools  and  emptying  fire-buckets,  are  destructive 
of  larvae  in  that  they  allow  these  to  dry.  In  some  in- 
stances, however,  it  is  not  possible  to  do  those  things, 


290       THE  PREVENTION   OF  EPIDEMICS 

and  other  methods  of  destroying  larvsB  must  be  resorted 
_  to.    Mosquito  larvae,  like  all  other  living 

^  ,         creatures,  have  their  natural  enemies,  and 

_  these  may  be  utilized.   Many  varieties  of 

small  J?6"^  devour  them,  and  some  of  these, 
for  instance  the  '*  millions  "  of  Barbados,  are  said  to 
do  the  work  so  thoroughly  as  to  quite  prevent  mosquito 
development  in  ponds  stocked  with  them.  Many  va- 
rieties of  fish  are  useful  for  this  purpose,  and  ponds, 
streams,  and  marshes  that  create  mosquito  nuisances 
can  be  profitably  stocked  with  them.  Other  water  ani- 
mals, such  as  tadpoles  and  some  kinds  of  beetles,  are 
also  reported  to  be  destructive  of  larvae.  The  larvae 
of  dragon  flies  are  certainly  so,  but  as  regards  the  tad- 
poles and  beetles  the  writer  cannot  speak  from  personal 
knowledge.  Ducks,  especially  mallards,  are  said  to  be 
very  destructive  to  mosquito  larvae. 

Moulds  and  other  germs  may  also  attack  the  larvae 
and  cause  their  death  through  disease.  Such  factors 
often  make  the  task  of  artificially  rearing  mosquitoes 
for  experimental  work  one  of  some  difficulty,  but,  so 
far  as  known,  they  have  not  been  used  to  reduce  their 
natural  occurrence.  That  the  natural  enemies  are  not 
alone  sufficient  to  destroy  all  larvae  is  evident  from  the 
fact  that  the  latter  are  occasionally  numerous  in  waters 
abounding  with  fish  and  tadpoles. 

Chemical 2)oisons  may  also  be  used,  but  they  are  dan- 
gerous and  can  only  be  applied  to  waters  which  are  not 
needed  and  which  should,  therefore,  be  drained  away 
or  otherwise  disposed  of. 

Very  extensive  use  has  been  made  in  the  Canal  Zone  of 
a  preparation  known  as  larvacide.  It  has  been  of  very 
great  value  in  many  places,  but  is  not  now  used  so  ex- 


INSECT-BORNE  DISEASES  291 

tenslvely  as  formerly  because  the  cost  of  it  has  increased 
so  greatly.  It  is  made  as  follows :  Crude  carbolic  acid 
of  a  specific  gravity  not  above  0.97  and  containing  fif- 
teen per  cent  of  tar  acids  is  heated.  Into  150  gallons  of 
this  200  pounds  of  crushed  and  sifted  common  rosin  are 
stirred,  and  then  30  pounds  of  caustic  soda  dissolved  in 
six  gallons  of  water.  These  amounts  yield  three  and  a 
half  barrels  of  larvacide,  which  for  use  is  diluted  with 
four  or  more  parts  of  water.  It  kills  mosquito  larvae  in 
five  minutes  in  a  dilution  of  1  to  5000. 

Oil,  preferably  crude  petroleum,  is  much  used  as  a 
means  of  destroying  larvae.  It  acts  mechanically.  The 
larvae,  though  living  in  water,  are  air-breathers,  and 
must  come  to  the  surface  at  intervals  of  a  minute  or  so 
for  that  purpose.  They  breathe  through  a  STnall  pipe  or 
tube  which  rises  above  the  back  near  the  tail,  and  which 
is  projected  from  the  surface  of  the  water  when  air  is  to 
be  taken  in.  If  the  water  be  covered  with  a  film  of  oil, 
this  little  tube  becomes  clogged  with  the  latter  as  it 
passes  through  it,  and  respiration  is  hindered  or  pre- 
vented so  that  the  wiggler  dies  of  suffocation.  Other 
oils  will  answer  as  well,  but  crude  petroleum,  because 
of  its  cheapness,  harmlessness  in  the  amounts  used,  and 
its  slow  evaporation,  is  preferred.  Refined  kerosene 
spreads  more  rapidly  and  evenly,  but  it  also  evaporates 
more  readily.  Some  crude  petroleums,  especially  such 
as  contain  a  considerable  asphalt  base,  as  do  California 
oils,  will  not  spread  well  if  applied  to  water  without  any 
diluent.  They  are  likewise  too  thick  to  be  pumped 
readily  with  small  (knapsack)  pumps  or  to  drop  relia- 
bly from  drip  cans  or  barrels.  It  has  therefore  been  the 
practice  in  the  Canal  Zone  to  "  cut "  this  heavy  oil  with 
larvacide  or  kerosene,  of  which  enough  is  added  and 


292       THE  PREVENTION   OF  EPIDEMICS 

mixed  in  to  overcome  the  faults  mentioned.  The  amount 
of  either  required  will  vary  from  two  to  twenty  per 
cent,  both  amount  and  choice  of  diluent  being  deter- 
mined by  circumstances.  At  the  present  writing  larva- 
cide  costs  two  and  a  half  times  as  much  as  kerosene, 
and  the  latter  is  therefore  ordinarily  preferred  as  a 
diluent  of  crude  oil,  though  special  cii-cumstances  make 
the  former  preferable  occasionally.  The  oil  may  be  ap- 
plied by  sprinkling,  spraying,  or  "painting  "  it  over  the 
surface.  In  the  last-named  method  it  is  applied  by  means 
of  a  saturated  rag  on  a  pole  that  is  rubbed  or  brushed 
about  on  top  of  the  water.  So  long  as  the  surface  is 
well  covered  the  method  of  application  does  not  matter. 
The  applications  should  be  renewed  as  necessary,  and 
the  frequency  of  this  will  depend  on  several  factors  that 
must  be  taken  into  consideration.  A  slight  current  or  a 
prevailing  wind  may  drive  ail  of  the  oil  to  one  side  of 
a  pond  or  may  remove  it  in  a  short  time.  In  such  cases 
the  renewal  must  be  more  frequent,  and  must  be  on  the 
side  from  which  the  oil  flows.  Light  oils  of  course  re- 
quire more  frequent  renewal  than  the  heavier  ones  that 
do  not  evaporate  so  readily.  The  surface  of  the  water 
should  not  be  left  uncovered  for  more  than  three  or 
four  days.  For  oiling  running  streams,  small  springs, 
drainage  ditches,  and  similar  water  runs,  use  may  prof- 
itably be  made  of  drip  cans  or  barrels.  These  may  be 
made  from  oil  barrels,  cans,  or  other  receptacles.  There 
are  many  ways  of  arranging  the  drip,  and  the  officer  or 
man  in  charge  can  devise  one  readily.  A  spigot  may  be 
used,  or  a  hole  made  in  the  receptacle  may  be  stopped 
with  a  plug  having  a  small  groove  cut  in  one  side,  or 
with  one  having  a  larger  groove  filled  with  wieking  or 
cotton  waste,  the  idea  being  to  have  a  drop  fall  often 


INSECT-BORNE  DISEASES  293 

enough  to  keep  the  water  covered  with  a  thin  coat  of 
oil.  In  order  to  make  the  drop  break  and  spread  when 
it  strikes  the  water  the  receptacle  should  be  raised  two 
or  three  feet  above  the  water  level.  Small  wet  places 
caused  by  a  seepage  of  water  from  a  hillside  or  else- 
where may  be  easily  and  profitably  oiled  by  pegging 
down  at  the  upper  edges  of  the  seepage  area  small 
bundles  (a  handful)  of  cotton  waste  saturated  with 
oil.  These  should  be  renewed  about  once  in  two  weeks, 
as  by  that  time  they  are  apt  to  be  hard  and  to  give  oS. 
an  insufficient  amount  of  oil.  Another  useful,  simple, 
and  successful  measure  of  treating  such  seepage  areas 
is  to  concentrate  the  moisture  into  tiles  or  ditches  and 
then  oil  it  if  necessary. 

If  water  be  drawn  off  through  a  pipe  running  well 
under  the  surface,  oiling  does  not  injure  it  for  house- 
hold uses  and  is  therefore  applicable  to  cisterns,  raiii- 
barrels,  and  other  domestic  supplies. 

Small  collections  of  larvae-containing  water  can  be 
easily  emptied  by  sweeping  or  other  means,  and  the 
larvae  promptly  die.  It  is  said  that  the  common  prickly 
pear  cactus  of  the  tropics  can  also  be  used  in  destroy- 
ing larvae.  "  The  thick,  fleshy  leaves  contain  a  muci- 
lage which  exudes  when  the  leaves  are  chopped  and 
added  to  water,  the  mucilage  rising  to  the  surface  and 
forming  a  practically  air-tight  covering  similar  to  that 
formed  by  oil." 

Under  ideal  conditions  mosquitoes  should  not  reach 

adult   life  where   an   active  anti-mosquito     ^ 

.    ,   .  -1        TT  J  •      Destnic- 

eampaign  IS  being  carried  on.   Under  possi- 
ble conditions  some  are  almost  certain  to  do      «  ,   , 
so,  and  under  the  best  conditions  obtaina- 
ble at  a  reasonable  cost  a  good  many  are  apt  to  be  found. 


294       THE  PREVENTION  OF  EPIDEMICS 

It  often  happens  too  that  a  camp  is  to  be  maintained 
at  a  place  for  so  short  a  time,  or  a  given  piece  of  con- 
struction work  is  so  small  and  so  unfavorably  located, 
as  to  make  adequate  measures  against  breeding  and 
larvaB  far  too  expensive  in  money  and  labor  to  be  prac- 
ticable or  worth  while.  In  such  circumstances  the  de- 
struction of  adult  mosquitoes  may  be  the  only  available 
means  of  getting  rid  of  them.  The  method  is  especially 
applicable  in  ridding  houses  of  mosquitoes  that  have 
bitten  yellow  fever  patients.  The  house  may  be  closed 
and  sealed  and  then  fumigated  with  sulphur,  the  vapor 
of  a  mixture  of  camphor  and  carbolic,  or  with  the  fumes 
of  pyrethrum.  The  first  two  kill  the  mosquitoes,  but  the 
pyrethrum  may  only  stupefy  them,  so  it  is  necessary 
to  gather  them  up  and  burn  them.  As  an  antimalarial 
measure,  fumigation,  because  it  cannot  be  continued 
daily  and  because  of  the  cumbersomeness  of  the  proc- 
ess, is  of  less  value  than  hand  catching,  which  may 
take  the  form  of  "swatting"  or  may  be  better  accom- 
plished by  the  use  of  a  tube  or  wide-mouthed  bottle 
containing  a  chloroform-saturated  pad.  This  is  best  pre- 
pared by  taking  a  neckless  vial  one  inch  in  diameter 
and  five  or  six  inches  deep,  filling  it  for  an  inch  with 
cut  rubber  bands,  and  placing  over  these  a  disk  of  blot- 
ting paper.  Then  pour  in  one  or  two  teaspoonfuls  of 
chloroform  and  allow  it  to  be  taken  up  by  the  rubber. 
When  this  tube  is  placed  and  held  over  a  resting  mos- 
quito, as  it  may  readily  be,  the  latter  drops  inert  in  a 
few  seconds.  To  aid  in  finding  the  mosquitoes  in  a  dark 
room  or  barrack  a  small  electric  seai-chlight  or  acety- 
lene lamp  is  most  useful,  and  greatly  aids  in  making 
the  catch  thorough.  With  it  mosquitoes  may  be  found 
in  dark  corners,  behind  doors,  and  on  articles  of  clothing, 


INSECT-BOUNE  DISEASES  295 

along  baseboards  and  mouldings,  and  in  other  places 
where  they  might  not  be  detected  otherwise. 

Certain  measures  have  value  as  tending  to  discour- 
age adult  mosquitoes  and  to  cause  their  abandonment 
of  a  neighborhood,  even  though  not  killing  them.  The 
most  important  of  these  are  the  removal  of  stagnant 
water,  in  which  they  may  lay  their  eggs,  and  the  cut- 
ting and  clearing  of  underbrush,  high  grass,  and  vines, 
on  or  in  which  they  take  shelter  and  rest  when  not 
busy.  Smoking  and  anointing  the  hands  and  face  with 
certain  volatile  oils  are  advocated  as  measures  of  per- 
sonal protection  for  the  same  purpose,  but  they  are 
not  to  be  relied  upon.  A  hungry  mosquito  will  bite 
through  a  layer  of  oil,  and  the  most  enthusiastic  smoker 
cannot  produce  such  clouds  as  to  protect  his  ankles, 
bands,  the  back  of  his  neck,  and  other  parts. 

The  more  effective  method  of  protection  from  adults 

is  in  the  use  of  screening  materials,  either  of  wire  or 

of  soft  fabrics.    Houses  with  wire-screened   _,     . 

Protec- 
windows   and   doors   are    in   general   use   ^       , 

throughout  our  country,  and  add  enor-  .  ,  . 
mously  to  the  comfort  and  safety  of  life  in 
the  hot  season.  They  have  a  very  great  influence  in  the 
prevention  of  all  mosquito-borne  diseases.  In  order  that 
full  benefit  may  be  realized  from  screening  it  is  impor- 
tant that  the  material  be  kept  in  good  condition,  holes 
patched  as  soon  as  found,  doors  provided  with  good 
springs,  cracks  in  floors  and  openings  under  the  corru- 
gations of  iron  roofing  stopped,  and  all  necessary  mea- 
sures taken  to  insure  the  complete  exclusion  of  mosqui- 
toes. For  this  purpose  it  is  necessary  to  have  buildings 
and  screens  inspected  frequently,  and  repairs  made  as 
needed. 


296       THE  PREVENTION   OF  EPIDEMICS 

Bed-nets  are  in  general  use  throughout  all  barracks 
in  the  tropics,  and,  if  in  good  condition  and  properly 
cared  for,  they  offer  adequate  protection  during  sleep- 
ing hours,  unless  the  sleeper  rolls  or  tosses  in  such  a 
way  as  to  bring  part  of  his  person  against  the  net,  in 
which  event  the  insects  feed  through  it.  It  is  neither 
pleasant  nor  practicable  to  spend  all  of  the  day,  or  even 
most  of  it  in  bed,  and  bed-nets  are  therefore  inadequate. 

Head-nets  are  at  times  of  value  for  night  use  in  cam- 
paign, and  rarely  so  for  common  use  in  the  daytime. 
Most  mosquitoes,  though,  do  not  bite  out  of  doors  in 
the  daytime,  especially  persons  who  are  in  motion. 

Adequate  clothing  is  of  course  important  in  ])rotect- 
ing  f i-om  mosquito  bites,  and  should  he  used  for  that 
■p  tflr  purpose.  In  spite  of  all  precautions  an  oc- 
^  ,        casional  mosquito  will  manacre  to  bite  the 

__  .       most  careful  man.    It  is  therefore  impor- 

.  froTTi  ^^^^  ^^  ^^^  ^^^^*  *^®  insects  do  not  become 
Infection  ^^^^^^-^^  ^^^^  disease,  and  yellow  -  fever, 
dengue,  and  malaria  patients,  particularly 
the  first-named,  should  be  kept  screened  or  doubly 
screened  during  the  entire  time  that  they  are  capable 
of  giving  infection.  For  this  purpose  it  is  essential  that 
all  cases  be  known,  and  early  diagnosis  and  prompt  noti- 
fication are  therefore  important,  especially  in  yellow 
fever,  which  is  so  deadly  and  yet  is  infectious  only  in 
its  early  stages.  In  addition  to  screening,  the  malarial 
patient  should  be  taking  quinine  to  free  his  blood  from 
germs.  As  natives  of  malarious  regions  are  very  ajit  to 
harbor  the  parasite  in  their  blood  and  to  keep  the  mos- 
quitoes in  their  neighborhoods  infected,  it  is  important 
to  keep  them  away  from  barracks  and  healthy  house- 
holds, and  it  is  wise  to  build  dwellings  or  barracks  at 


INSECT-BORNE  DISEASES  297 

some  distance  from  native  towns  or  habitations.  Na- 
tives working  about  soldiers'  quarters  should  be  re- 
quired to  take  quinine  regularly  and  to  observe  the 
general  rules  of  hygiene. 

Quiniue  has  been  much  and  successfully  used  as  a 
preventive  of  malaria.  The  most  extensive  use  of  it  has 
been  by  the  government  in  Italy,  and  ^J  j-^  ■  • 
the  Germans  in  some  of  their  African  col-  jl 
onies.  It  may  be  said  that  there  are  two  ,  .  ^" 
methods  of  using  quinine  in  prophylaxis, 
and  the  difference  of  opinion  concerning  the  value  of 
this  method  of  control  arises  from  a  confusion  of  them. 
One  method  consists  in  the  daily  administration  of 
small  doses  of  from  two  to  five  grains  of  quinine.  The 
evidence  concerning  the  value  of  this  method  is  con- 
flicting and  many  instances  have  been  cited  to  show 
that  it  is  of  little  or  no  use.  The  other  method  is  the 
administration  of  doses  that  might  be  therapeutic  if  the 
person  were  actually  infected,  and  it  is  highly  effective 
in  keeping  down  the  disease,  by  reason  of  the  fact  that 
parasites  entering  the  blood  are  promptly  destroyed, 
and  of  the  other  fact  that  actually  infected  persons  have 
their  peripheral  blood  freed  from  parasites  and  are 
therefore  not  infective  for  mosquitoes.  It  is  probable 
that  a  large  part  of  the  Italian  and  German  successes 
with  quinine  prophylaxis  lay  in  the  fact  that  it  was 
largely  a  treatment  of  malaria  carriers.  Such  treatment 
alone,  if  it  could  be  carried  out  thoroughly  every- 
where, would  suffice  to  eliminate  the  disease.  Like  many 
other  desirable  measures,  this  is  impracticable.  When 
a  command  is  temporarily  placed  in  a  malarious  re- 
gion without  other  adequate  protection,  it  is  advisable 
to  place  the  whole  force  on  quinine.  The  most  satisfac- 


298       THE  PREVENTION  OF  EPIDEMICS 

tory  dosage  is  generally  about  ten  grains.  This  may  be 
given  daily,  and  when  it  is  desired  to  reduce  the  total 
intake  of  the  drug  the  interval  between  doses  should  be 
lengthened,  rather  than  giving  a  smaller  dose,  the  idea 
beiug  to  have  an  efficient  concentration  of  quinine  in 
the  blood  occasionally  rather  than  to  have  an  insufficient 
amount  present  at  all  times.  It  should  be  borne  in  mind 
that  many  persons  are  very  susceptible  to  the  action  of 
quinine  and  are  apt  to  suffer  much  discomfort  from  the 
use  of  a  dose  of  this  size.  In  such  cases  the  surgeon 
must  decide  whether  the  individual  should  use  the  drug 
as  a  prophylactic,  and,  if  so,  how. 

Experience  indicates  that  the  work  of  mosquito  "  ex- 
termination "  is  more  effectively  done  if  regular  forces 
__  are  kept  at  it  to  the  exclusion  of  other  work, 

and  every  tropical  or  mosquito-infected  post 
^  .       ,         should   have  such  a  "mosquito  brigade." 

Men  kept  on  the  work  soon  learn  the  lo- 
cations and  habits  of  the  insects  and  become  expert  in 
destruction  or  prevention.  When  the  work  is  left  to 
householders  or  to  general  fatigue  parties,  it  is  usually 
neglected  and  the  plague  continues  unabated. 

FLEA-BORNE   DISEASES 

Bubonic  plague  is  the  most  important  disease  trans- 
mitted to  man  by  fleas,  and  it  will  be  discussed  here 
_.  only  briefly,  as  mention  has  already  been 

made  of  it.  The  disease  is  due  to  a  small 
bacillus  that  is  possessed  of  great  vitality,  so  that  the 
virus  may  persist  for  a  long  time.  Extensive  investi- 
gations in  different  parts  of  the  world,  but  principally 
in  India,  have  clearly  demonstrated  that  the  disease 
is  usually  transmitted  in  the  manner  here  indicated, 


INSECT-BORNE   DISEASES  299 

though  it  is  occasionally  communicated  in  other  ways. 
The  relation  of  rats  to  plague  epidemics  has  already 
been  discussed.  A  Russian  observer  states  that  bedbugs 
also  may  transmit  it.  In  Java  it  was  found  that  body 
lice  taken  from  plague  patients  contained  plague  bacilli. 
It  is  possible  that  they  might  transmit  the  disease. 
Pneumonic  plague  and  its  transmission  by  contact  and 
droplet  infection  have  been  discussed,  and  experiments 
carried  out  in  Manchuria  and  later  in  Manila  indicate 
that  during  coughing,  even  when  no  visible  droplets  are 
expelled,  large  numbers  of  bacilli  are  widely  dissemi- 
nated, and  the  wearing  of  masks,  gowns,  and  eyeglasses 
by  doctors,  nurses,  and  others  attending  patients  with 
this  form  of  the  disease  is  important.  The  germs  are  ex- 
creted by  plague  patients  in  the  spit,  urine,  the  pus  from 
ulcers  and  buboes,  and  possibly  the  feces,  so  that  dust- 
infection  and  contact  may  account  for  some  cases.  Nev- 
ertheless the  rat  and  the  rat  flea  are  responsible  for  the 
majority  of  cases  and  epidemics,  and  the  measures  of 
prevention  and  control  are  aimed  at  these  two.  The 
following  facts,  among  others,  constitute  the  reasons 
and  justification  for  such  measures. 

Rats  abound  particularly  in  houses  and  neighbor- 
hoods which,  because  of  poor  policing  or  other  sani- 
tary neglect,  afford  them  food,  shelter,  and   --  .,     , 
breeding-places.    They  are  very  susceptible      ,  TrtinH 
to  plague   and   are   probably  the  natural  -y.iog4o„ 
hosts  of  the  disease.    When  severely  in- 
fected they  may  have  the  germs  in  their  blood  in  enor- 
mous numbers,  as  many  as  100,000,000  in  a  cubic 
centimetre  of  blood.    All  rats  have  fleas,  which  remain 
on  them  imtil  death,  when  they  leave  them  and  seek 
other  hosts,  usually  rats,  but  in  their  absence  men  or 


300       THE  PREVENTION  OF  EPIDEMICS 

other  animals.  Fleas  breed  in  the  nests  of  their  hosts, 
live  on  their  blood,  and  in  biting  may  readily  ingest 
as  much  blood  as  may  contain,  in  the  case  of  plague 
septicemia,  5000  plague  bacilli.  These  bacilli  may  re- 
main alive  and  virulent  in  the  flea's  stomach  for  as 
long  as  fifteen  days,  and  then  be  ejected  when  the  flea 
bites  again,  and  gain  entrance  to  the  wound  made  by 
the  insect,  thus  producing  infection. 

While  the  rat  flea  is  the  insect  principally  concerned 
in  carrying  the  disease,  dog,  cat,  and  human  fleas  may 
_  .,    __.        act  the  part.   The  following  is  the  ordinary 

life  history  of  the  rat  flea  in  Bombay.  The 
—      —,.        egga  are  laid  at  all  seasons,  from  one  to  five 

at  a  time,  and  hatch  in  about  two  days.  The 
larvje  are  wormlike  and  resemble  some  small  fly  and  wee- 
vil larvse.  They  live  on  almost  any  kind  of  refuse,  often 
on  parental  excrement,  and,  after  varying  periods  of 
not  less  than  one  week,  spin  cocoons  of  fine,  silky 
thread,  which  become  covered  with  dust  and  rubbish 
and  are  difficult  to  distinguish.  The  adult  fleas  escape 
from  these  cocoons  after  one  or  two  weeks  and  seek 
a  host,  as  they  can  only  live  on  fluid  food,  especially 
blood.  The  most  favorable  temperature  for  breeding 
is  from  50°  to  85°  F.,  and  when  the  mean  is  above  or 
below  this  range,  breeding  stops  or  is  delayed,  a  fact 
which  partly  accounts  for  the  seasonal  variations  of 
epidemics.  Each  species  of  flea  has  its  own  host,  which 
it  prefers  to  all  others,  but  in  the  absence  of  that  host, 
and  after  a  period  of  starvation,  it  will  seek  others. 
The  rat  flea,  for  instance,  will  not  usually  bite  man 
until  three  days  after  the  death  of  its  rat  host. 

It  is  to  be  noted,  however,  that  the  "  rat  flea  "  does 
not  mean  merely  one  species  of  flea.  The  common  rat 


INSECT-BORNE  DISEASES  301 

flea  of  the  Philippines  is  not  the  same  as  the  one  most 
common  in  India  and  Java.  The  life  history  and  breed- 
ing liabits  of  rat  fleas  therefore  vary  on  this  account 
and  others.  In  Java,  where  the  climate  is  very  uniform, 
the  mean  temperature  being  from  73  to  75  degrees 
Fahrenheit  all  the  year  and  the  humidity  not  less  than 
70  per  cent  saturation,  flea  breeding  and  plague  spread 
have  no  seasonal  variation  as  in  India  and  other  places. 
In  Java,  the  eggs  of  the  common  rat  flea  (^.  cheopis) 
hatch  in  from  four  to  eight  days  and  the  larvae  develop 
into  mature  fleas  in  thirty-one  to  fifty-two  days.  The 
adults  lived,  in  the  laboratory,  only  two  or  three  weeks. 
Humidity  is  favorable  to  their  development,  as  when  the 
air  is  driest  fewer  eggs  hatch  and  both  the  larval  and  pu- 
pal stages  are  prolonged.  Infectious  plague  bacilli  were 
there  found  in  fleas  eighteen  days  after  their  ingestion. 
In  the  Canal  Zone  fleas  begin  to  leave  the  body  of  a  rat 
almost  immediately  after  its  death,  and  all  have  left  at  the 
end  of  two  hours.  The  common  rat  flea  of  England  may 
have  its  pupal  stage  prolonged  for  months,  cold  weather 
so  influencing  it.  In  rubbish  the  adults  of  this  flea  will 
live  apparently  unfed  for  as  long  as  seventeen  months, 
without  rubbish  for  one  momth.  It  is  said  that  this  flea 
will  feed  on  man  as  readily  as  on  rats,  but  that  it  does  not 
breed  until  it  has  fed  on  rat  blood.  In  India  the  laying  of 
eggs,  the  development  of  eggs  into  larvae,  of  larvae  into 
pupae,  and  of  pupae  into  adults  are  all  subject  to  marked 
seasonal  variations,  being  most  active  in  wet  and  tem- 
perate weather  and  least  so  under  dry  and  hot  con- 
ditions. 

The  measures  to  be  taken  for  the  prevention  and  sup- 
pression of  epidemics  are  indicated  by  the  facts  recorded 
above.  They  must  embrace  numerous  and  costly  expe> 


302       THE  PREVENTION  OF  EPIDEMICS 

dients  unless  the  fight  is  begun  in  earnest  at  the  first 
_  appearance  of  cases,  and  the  disease  eradi- 

^  ,     cated  before  it  has  had  an  opportunity  to 

„  spread.    Failure  to   take  vigorous   action 

X        eai'ly   resulted   in   the   spread    of    plague 
„   .  through  San  Francisco,  so  that  the  work 

J       .  and  expense  of  fighting  it  had  to  be  con- 

tinued for  years. 
General   hygiene  is  of  great  importance  as  lessen- 
ing  the  numbers   of   rats   and   fleas,  both  of   which 
abound  in  the  presence  of  filth.  Such  measures  must 
include  the  removal  or  destruction  of  rubbish  and  other 
material  in  which  the  rats  hide  or  make  their  nests,  the 
stopping  of  their  holes  or  other  means  of  access  to  walls, 
floors,  and  other  hiding-places,  the  preven- 
tion  of  their  access  to  garbage  and  other 
^°  food-supplies.    They  must  also  include  such 

cleanliness  of  persons,  domestic  animals,  houses,  streets, 
and  communities,  as  will  make  the  presence  of  fleas, 
bedbugs,  and  lice  improbable. 

Special  measures  should  also  be  adopted  against  rats, 
such  as  their  destruction  by  poisoning,  trapping,  and 
disease.    The  last-named  measure  is    em- 
ployed by  scattering  bait  contaminated  with 
°  cultures  of  a  bacillus  that  causes  epidemics 

among  rats,  but  does  not  harm  man  or  his 
domestic  animals.  The  keeping  of  cats  has  been  advo- 
cated as  a  useful  anti-plague  measure,  and  it  is  prob- 
ably of  value.  Old  and  rat-riddled  buildings  may  need 
to  be  destroyed.  Good  buildings  should  be  made  rat- 
proof  by  means  of  concrete,  cement,  and  sheet-iron. 
Stables  and  warehouses  will  require  particular  atten- 
tion, and  their  floors,  walls,  and  roofs  should  be  made 


INSECT-BORNE  DISEASES  303 

as  rat-proof  as  possible.  Because  of  the  frequency  with 
which  rats  are  transported  in  ships,  all  wharves  and 
docks  must  be  freed  from  them  as  far  as  possible,  ships 
from  infected  ports  should  be  required  to  anchor  off- 
shore, and  all  cables  or  chains  leading  to  shore  or  to 
other  boats  should  be  provided  with  shields  that  rats 
cannot  pass.  Sewers  should  be  well  flushed  to  keep 
them  clean,  and  should  be  screened  or  barred  so  that 
rats  may  not  pass  from  them  to  houses  or  other  build- 
ings. Houses  or  boats  known  to  be  infested  should  be 
tightly  closed  and  fumigated  with  sulphur  fumes  or 
other  poisonous  gas  that  will  destroy  the  rats. 

The  greatest  of  all  anti-rat  measures,  however,  is 
cleanliness.  A  city,  a  house,  a  wharf,  or  a  ship  may  be 
as  "  rat- proof "  as  it  is  possible  to  make  it,  and  if  it  is 
not  kept  clean  and  well  policed  it  may  swarm  with  rats, 
despite  traps,  cats,  and  poisons.  On  the  other  hand,  a 
building  far  from  rat-proof  may  be  kept  free  from  rats 
without  any  of  those  means.  Given  rat-proof  food  storage 
and  garbage  cans  for  kitchens  and  rat-proof  grain  bins 
for  stables,  and  even  they  can  be  kept  freer  from  rats 
than  can  other  similar  places  with  poisons,  traps,  and 
cats,  but  without  adequate  food  protection. 

As  helpful  in  fighting  rats  it  may  be  mentioned  that 
they  can  climb  almost  anything,  even  an  iron  pipe  or  a 
bamboo  pole,  may  burrow  as  deep  as  two  and  a  half 
feet,  can  jump  upward  eighteen  inches,  "can  surmount 
any  horizontal  projection  of  less  than  six  inches  if  the 
material  be  such  as  they  can  climb  on  a  vertical  sur- 
face, and  can  walk  along  a  thin  suspended  wire."  A 
rat  released  450  feet  from  shore  reached  land  in  six 
minutes,  and  one  released  1300  feet  from  shore  swam  a 
total  of  1500  feet  and  reached  land  in  fifty-five  minutes. 


304       THE   PREVENTION   OF  EPIDEMICS 

The  interesting  fact  that  during  a  series  of  epidem- 
ics there  is  evolved  a  race  of  rats  relatively  immune  to 
plague  has  been  observed  in  India.  In  plague-free  cities 
(Madras,  Raipur,  Banda)  infected  rats  show  a  case 
mortality  varying  from  90  to  100  per  cent,  while  in 
plague-stricken  places  (Cawnpore,  Lucknow,  Poona) 
only  20  to  40  per  cent  succumb.  This  immunity  is  trans- 
mitted from  parent  to  offspring  and  is  not  acquired. 

The  most  important  measures  against  fleas  are  pro- 
bably good  general  policing,  the  maintenance  of  clean 
_-  floors,  and  the  absence  of  litter  and  waste 

in  which  they  may  breed ;  but  other  mea- 

.        sures  are  also  of  value,  and  among  them 
against  ,  .1,1..  1 

_,,  may  be  mentioned  the  use  01  msect-powder 

and  antiseptic  soaps  on  domestic  animals, 
the  use  of  foot-covering  and  other  adequate  clothing, 
and  the  use  of  petroleum  on  floors  and  streets,  and  of 
putty,  paint,  and  antiseptic  solutions  in  cracks  of  floors 
and  walls.  The  Indian  Plague  Commission  reports  that 
for  practical  purposes  flake  naphthalin  is  the  most  gen- 
erally effective  agent  to  use  against  fleas  in  all  stages 
of  their  life  cycle.  It  may  ordinarily  be  used  in  its  dry 
form,  but  to  get  it  into  cracks  and  crevices  it  may  be 
dissolved  in  benzene.  For  the  treatment  of  rat  holes 
they  advise  the  use  of  carbolic  emulsion  (larvacide  is 
such),  or  of  a  soap-petroleum  emulsion,  to  which  flake 
naphthalin  has  been  added.  A  soap-petroleum  emulsion 
may  be  made  by  combining  80  per  cent  of  crude  petro- 
leum with  twenty  per  cent  of  whale  oil  soap  (or,  pre- 
sumably, other  coarse  soap).  A  room  thoroughly  washed 
and  sprayed  with  this  is  said  to  be  freed  from  fleas.  As 
previously  suggested,  the  use  of  crude  oil  in  road-mak- 
ing, as  is  now  much  practiced  in  this  country,  will  pro- 


INSECT-BORNE   DISEASES  305 

bably  prove  of  value  in  lessening  the  number  of  fleas. 
Fleas  may  be  collected  in  rooms  or  houses  known  to 
be  infected  by  turning  guinea  pigs  loose  in  them.  The 
fleas  attack  the  animals,  and  may  then  be  stupefied  with 
chloroform,  combed  from  the  hair,  and  burned. 

Every  case  of  plague  in  man  or  rat  should  be  promptly 
reported,  so  that  proper  measures  of  isolation,  fumiga- 
tion, disinfection,  etc.,  may  be  instituted 
early.  All  rats  found  dead,  as  well  as  those 
trapped  or  otherwise  captured,  should  be 
tagged  with  a  statement  of  the  time  and 
place,  and  then  examined  for  the  presence  of  plague. 
If  it  is  found  that  they  have  the  disease,  active  measures 
must  be  begun  at  once  in  the  neighborhood  from  which 
they  came.  All  persons  afflicted  should  be  isolated  and 
their  discharges  cared  for.  Disinfection  of  houses  and 
effects  should  follow. 

Anti-plague  vaccination  has  been  considerably  used 
iu  India  for  some  time  now,  and  the  following  state- 
ments as  to  results  have  been  published :  -TT-e-j-- j» 
"  1.  In  a  native  of  India,  who  is  more  sus-  ^ 
ceptible  to  the  disease  than  Africans,  Euro- 
peans, and  some  other  races,  the  inoculation  now  in  force 
reduces  the  liability  to  attack  to  less  than  one  third  of 
what  it  is  in  a  non-inoculated  Indian.  2.  In  the  one  third 
of  cases  which  still  occur,  the  recovery  rate  is  at  least 
double  that  in  the  non-inoculated  attacked.  The  ulti- 
mate result  is  a  reduction  of  plague  mortality  by  some 
eighty-five  per  cent.  3.  In  an  inoculated  European  an 
attack  of  plague,  if  it  subsequently  occurs,  has  so  far 
always  ended  in  recovery.  4.  The  inoculation  is  appli- 
cable to  persons  already  infected  and  incubating  plague, 
and  prevents  the  appearance  of  symptoms  or  else  miti- 


306       THE  PREVENTION   OP  EPIDEMICS 

gates  the  attack."  Government  reports  show  that  in 
1911  there  were  distributed  1,211,170  doses  of  plague 
vaccine,  and  that  among  118,148  vaccinated  persons 
there  was  a  plague  incidence  of  7.96  cases  per  1000, 
with  a  case  mortality  of  39.5  per  cent ;  while  among 
321,621  unvaccinated  persons  the  incidence  was  34.4 
per  1000,  with  a  case  mortality  of  78.6  per  cent,  indi- 
cating results  as  good  as  those  claimed  by  the  origina- 
tor of  the  method  and  quoted  above.  Similar  results 
were  reported  from  Java  for  the  same  year,  yet  the 
statement  has  been  published  that  the  use  of  vaccine  has 
there  been  abandoned.  The  Indian  government  report 
just  referred  to  states  that  the  protective  power  of  the 
vaccine  varies  with  the  severity  of  the  reaction  it  causes. 

LOUSE-BORNE   DISEASES 

Of  these  typhus  and  the  relapsing  fever  of  most 
parts  of  the  world  have  been,  in  former  times,  among 
the  world's  great  scourges,  and  while  often  known  as 
jail  fever,  ship  fever,  camp  fever,  and  famine  fev^r, 
their  appearance  was  by  no  means  so  limited  as  those 
names  would  indicate,  and  palaces  and  great  persons 
were  not  strangers  to  the  diseases  or  their  carriers.  At 
present  these  diseases  are  almost  unknown  in  our  coun- 
try, England,  Germany,  and  the  other  highly  civilized 
Western  countries,  but  in  many  parts  of  the  world  one 
or  both  are  still  rather  common,  notably  in  Mexico, 
where  the  typhus  is  known  as  "  tabardilla"  in  north 
Africa,  in  Bussia,  in  Asia,  and  especially  in  China, 
while  a  large  epidemic  of  typhus  prevails  in  Japan,  es- 
pecially in  Tokio,  at  the  time  of  this  writing. 

Brill's  disease,  of  the  immigrant  sections  of  some  of 
our  cities,  is  a  mild  form  of  typhus. 


INSECT-BORNE  DISEASES  307 

The  germ  causing  typhus  has  not  been  identified  to 
the  satisfaction  of  most  workers.  That  causing  relaps- 
ing fever  has  been  known  for  a  longer  period  than  most 
other  germs  causing  human  diseases,  and  is  a  spirillum, 
a  motile,  corkscrew-shaped  organism  that  is  readily 
detected  in  the  circulating  blood  at  certain  periods  of 
the  disease. 

It  has  been  shown  that  both  of  these  diseases  are  or- 
dinarily conveyed  by  body  lice,  but  there  is  also  evi- 
dence that  both  may  be  conveyed  by  head  lice,  and  the 
investigation  of  a  case  of  typhus  in  an  American  sol- 
dier in  China  suggested  to  the  writer  that  the  crab  louse 
might  also  carry  that  disease.  Typhus  is  ordinarily 
transmitted  by  the  bites  of  the  lice,  but  this  is  only 
exceptionally  true  of  relapsing  fever,  of  which  disease 
the  insects  are  contaminative  carriers,  and  in  which  in- 
fection usually  occurs  when  the  insect  is  crushed  and 
its  juices  rubbed  into  the  skin  by  scratching.  There  is 
evidence  that  both  diseases  and  the  power  to  infect 
with  them  may  be  passed  by  the  lice  to  their  offspring. 
The  following  observations  on  lice  are  not  without  in- 
terest. Body  lice  are  more  hardy  than  head  lice  and 
outlive  them  under  adverse  conditions.  Both  survive 
longest  when  maintained  at  a  temperature 
of  about  82  degrees  Fahrenheit,  in  a  moist 
atmosphere,  and  allowed  to  feed  twice  daily.  ^ 
Body  lice  reared  in  a  vial  worn  next  to  the 
body,  and  allowed  to  feed  twice  daily,  afforded  facilities 
for  the  following  observations  by  an  English  natural- 
ist. A  female  lived  one  month,  copulated  repeatedly 
with  a  male  that  died  on  the  seventeenth  day,  and  later 
with  another  male.  She  laid  124  eggs  in  twenty -five 
days.  The  eggs  hatched  in  eight  days  under  favorable 


308      THE   PREVENTION  OF  EPIDEMICS 

conditions,  but  not  at  all  in  the  cold.  When  larvje 
emerge  they  feed  at  once  if  given  an  opportunity.  They 
reach  the  adult  stage  on  the  eleventh  day,  after  three 
moults.  The  adults  begin  to  copulate  five  days  after 
the  last  moult  and  live  about  three  weeks  thereafter. 
Unfed  lice  die  in  five  days  or  less,  unfed  larvae  in  thirty- 
six  hours. 

The  above  facts  being  known,  the  method  of  preven- 
tion of  typhus  and  relapsing  fever  is  obvious,  —  avoid- 
_^  ance  of  lice.  To  avoid  lice,  cleanliness  of 

person,  clothing,  and  associations  is  neces- 
sary. To  get  rid  of  them,  infested  clothing 
should  be  boiled  or  steamed,  infested  bodies  washed, 
infested  hair  shaved  or  soaked  for  fifteen  minutes  in  a 
solution  of  one  part  carbolic  in  forty  parts  of  water, 
infested  barracks  or  tents  emptied  and  thoroughly 
scrubbed  and  disinfected. 

FLY-BORNE   DISEASES 

In  addition  to  typhoid  and  other  diseases  discussed  in 
preceding  parts  of  this  book,  in  which  the  fly  acts  as  a 
_.        .  simple  carrier  of  infection  but  does  not  ac- 

_.   ,  tually  introduce  it  into  the  body,  the  sleep- 

ing sickness  of  Africa  is  a  very  important 
disease.  It  is  introduced  by  a  biting  fly,  and  is  caused 
by  a  small  animal  parasite  very  much  like  that  causing 
surra  in  horses  in  the  Philippines  and  other  places. 

The  only  means  of  prevention  yet  known  are  the 
avoidance  of  fly  bites,  the  cleaning  of  undergrowth 
from  near  streams,  and  the  avoidance  of  infected  local- 
ities. The  disease  has  spread  widely  throughout  Africa 
within  a  comparatively  few  years,  has  caused  enormous 
fatalities,  and  practically  depopulated  large  districts. 


INSECT-BORNE   DISEASES  309 

All  of  the  European  countries  having  colonies  south 
of  the  Sahara  have  done  much  work  and  spent  much 
money  in  their  efforts  to  control  it.  Whether  or  not 
there  are  two  or  three  kinds  of  sleeping  sickness,  caused 
by  two  or  three  species  of  trypanosomes,  is  not  at  pres- 
ent settled,  but  at  any  rate  all  sleeping  sickness  is  try- 
panosomiasis and  is  transmitted  by  tsetse  flies.  Afri- 
can antelope  appear  to  be  reservoirs  of  the  disease,  and 
the  question  of  their  extermination  is  being  discussed. 
The  value  of  proper  clothing  as  a  protection  from  fly 
bites  is  not  to  be  forgotten.  It  appears  that  sleeping 
sickness  is  relatively  more  common  among  European 
women  in  Africa  than  among  the  men,  a  fact  probably 
partly  accounted  for  by  the  less  degree  of  protection 
of  this  sort  afforded  by  the  women's  clothing,  especially 
by  their  stockings  as  compared  with  the  men's  leggings 
or  trouser  legs. 

In  the  Balkans,  in  many  places  in  or  about  the  Med- 
iterranean, in  India,  and  elsewhere,  a  short,  sharp,  pain- 
ful fever,  called  "three  day"  or  "sand-fly     _, 
fever,"  has  been  found  to   be  carried  by     _ 
sand  flies  or  midges  of  the  genus  Phlehoto-    p^   _.. 
mus^  very  small  insects  that  breed  in  crev- 
ices of  stone  walls  and  similar  places.  The  disease  is 
not  fatal  and  bears  a  clinical  resemblance  to  dengue. 
Prevention  lies  in  avoidance  of  bites,  a  difficult  matter 
where  the  flies  abound,  as  they  readily  pass  through 
most  mosquito  screening. 

TICK-BORNE   DISEASES 

The  most  important  tick-borne  diseases  that  have 
been  well  studied  are  the  African  relapsing  fever,  due 


310       THE  PREVENTION  OF  EPIDEMICS 

to  a  spirillum,  and  the  spotted  or  tick  fever  of  western 
Montana,  due  to  an  unknown  organism.  The  latter  dis- 
ease may  affect  American  troops,  as  Fort  Missoula  is 
in  the  country  in  which  it  occurs.  No  case  has  yet 
appeared  in  a  soldier.  Both  of  these  diseases  may  be 
transmitted  by  ticks  that  have  bitten  sick  persons,  or 
by  the  young  of  such  ticks.  The  methods  of  prevention 
thus  far  known  to  be  of  value  are  the  avoidance  of  in- 
fected districts  and  of  tick  bites.  In  the  case  of  spotted 
fever  the  season  is  short  and  the  danger  is  slight,  except 
from  the  first  of  March  to  the  middle  or  end  of  July. 
If  infected  regions  must  be  visited,  the  use  of  adequate 
clothing  and  of  head-nets  and  bed-nets  wiU  be  of  value, 
but  probably  not  absolutely  protective.  Wood-ticks, 
such  as  convey  spotted  fever,  disappear  as  forests  are 
cleared  and  the  land  cultivated.  The  ticks  that  convey 
the  African  fever  abound  principally  in  rest-houses  and 
old  camps,  and  cleanliness,  avoidance  of  old  huts  and 
old  camp-sites,  and  the  use  of  nets,  would  seem  the  best 
measures  of  protection. 

DISEASES   BORNE  BY   BEDBUGS 

As  stated  above,  a  number  of  diseases  have  been 
credited  to  the  agency  of  these  pests,  and  the  evidence 
incriminating  them  is  sufficiently  strong  to  make  their 
avoidance  and  destruction  a  necessity,  as  well  as  an 
aesthetic  measure.  The  mere  fact  that  they  are  and  for 
an  unknown  period  have  been  closely  parasitic  on  man 
is  presumptive  evidence  of  the  possibility  of  one  or  more 
human  diseases  having  adopted  them  as  carriers,  be- 
cause a  study  of  the  insect-borne  diseases  that  have 
just  been  discussed  shows  that  each  of  them  is  borne 
by  an  insect  closely  associated  with  the  animal  host.  In 


INSECT-BORNE  DISEASES  311 

most  instances  in  which  the  carrier  is  not  a  parasite 
especially  associated  with  man  himself,  for  example 
the  rat  flea  and  the  tsetse  fly,  it  could  reasonably  be 
claimed  that  man  is  only  accidentally  the  subject  of 
the  diseases,  which  in  the  instances  cited  belong  to  the 
rat  and  the  wild  game.  Bedbugs  are  so  generally  recog- 
nized as  vermin  and  indicators  of  uncleanliness  that  their 
presence  constitutes  a  cause  of  shame  in  a  well-regulated 
house  or  barracks.  The  avoidance  of  diseases  trans- 
mitted by  them  depends  on  scrupulous  cleanliness  of 
houses,  beds,  and  bedding,  and  the  avoidance  of  those 
that  are  not  clean.  Soldiers,  though  living  in  clean  sur- 
roundings, may  expose  themselves  to  bites  in  seeking 
sexual  indulgence  or  drink,  and  they  should  be  taught 
by  precept  and  example  not  to  do  so. 


CHAPTER  XV 

VENEREAL   DISEASES 

The  term  venereal  is  usually  applied  to  the  diseases 
resulting  from  illicit  and  impure  sexual  intercourse. 
The  principal  members  of  the  group  are  syphilis, 
chancroid  or  soft  chancre,  and  gonorrhoea.  In  a  gen- 
eral sense  the  adjective  is  truly  descriptive,  but,  as 
stated  before,  it  is  not  always  so,  and  all  of  these  trou- 
bles may  be  contracted  by  persons  absolutely  innocent 
of  illicit  connections  or  even  of  proper  intercourse.  It 
is,  however,  so  generally  true  that  in  soldiers,  at  least, 
the  diseases  result  from  improper  conduct,  that  they  are 
assumed  to  be  "  not  in  line  of  duty,"  and  a  report  to  the 
contrary  requires  special  explanation. 

These  diseases  are  particularly  frequent  in  youth  and 
C*  p  al  ^^^^y  manhood,  and  it  is  stated  that  "  about 
—  95  per  cent  of  all  cases  of  gonorrhoea  occur 

between  the  ages  of  sixteen  and  thirty." 
The  reasons  for  this  are  numerous,  and  some  of  them 
may  be  summarized  as  follows :  — 

1.  This  is  the  period  at  which  sexual  desire  and 
power  are  at  their  maximum.  After  the  age  of  thirty 
some  decline  in  both  has  usually  begun. 

2.  It  is  also  a  period  in  which  judgment  is  not  ma- 
tured, self-control  not  well  developed,  and  ignorance 
not  dissipated,  so  that  the  future  wife  and  family  ex- 
ercise no  claims  and  venereal  diseases  are  regarded  as 
trifling. 

3.  Manhood  and  virility  are  synonymous  terms,  in 


VENEREAL  DISEASES  313 

common  usage  as  well  as  in  the  dictionaries,  and  youth 
delights  in  demonstrating  its  manhood. 

4.  Most  men  are  married  by  the  time  they  reach  th« 
age  of  thirty,  and  are  less  apt  to  be  exposed  to  infec' 
tion  thereafter. 

The  soldier  is  probably  more  apt  to  contract  venereal 
diseases  than  the  young  civilian,  because  his  associates 
are  practically  all  males ;  his  topics  of  conversation  are 
largely  such  as  are  only  handled  in  "  stag  "  gatherings ; 
he  is  removed  from  the  restraints  of  the  family  and  of 
the  public  opinion  that  can  most  influence  him,  that  of 
his  friends  and  acquaintances  at  home ;  he  may  at  times 
find  it  difficult  to  obtain  access  to  other  female  society 
than  that  of  prostitutes,  and  these  are  always  to  be 
found.  He  may  also  drink  a  bit  to  demonstrate  his  man- 
liness, to  relieve  his  loneliness,  to  be  companionable, 
or  simply  because  he  is  "  a  young  man,  void  of  under- 
standing " ;  and  then,  with  judgment  perverted  and 
desires  inflamed  by  alcohol,  he  forgets  danger  and  seeks 
intercourse  where  he  can  most  readily  obtain  it. 

For  many  years  our  army  has  had  the  highest  non- 
effective rate  of  any  army  publishing  its  statistics.  The 
reasons  for  this  were  probably  several  in  number,  though 
not  all  well  understood.  At  present  the  condition  is 
improving,  official  reports  showing  the  constantly  non- 
effective rate  in  the  army  stationed  in  the  United  States 
to  have  fallen  from  11.44  per  1000  in  1909  to  3.58  per 
1000  in  1913. 

In  his  annual  report  for  1913  the  Surgeon  General  as- 
cribed this  improvement  to  two  main  factors:  the  general 
use  of  preventive  measures  after  intercourse,  and  the 
stoppage  of  pay  during  absence  from  duty  on  account 
of  illness  due  to  the  soldier's  own  misconduct. 


314       THE  PREVENTION  OF  EPIDEMICS 

When  to  this  is  added  the  time  lost  because  of  troubles 
indirectly  due  to  venereal  diseases,  and  the  duties 
poorly  performed  because  of  them,  it  is  probably  no 
exaggeration  to  say  that  it  was  almost  as  though  one 
regiment  had  been  eliminated  from  the  service. 

The  company  officer  cannot  expect  to  work  a  revolu- 
tion in  the  morals  of  his  men,  or  to  make  chastity  a 
_  .      general  characteristic  of  them,  but  he  can 

__  exercise  some  influence  in  that  direction 

,  _  by  his  personal  conduct  and  example,  by 

choosing  non-commissioned  officers  who 
will  probably  do  the  same,  by  making  the 
soldier's  surroundings  pleasant  and  attractive,  and  en- 
couraging him  to  find  his  amusement  and  recreation  in 
the  post,  by  providing  good  reading-matter  and  help- 
ing to  make  the  most  of  the  post  exchange  as  a  place 
of  recreation  and  amusement,  and  by  giving  his  men 
instruction  as  to  the  dangers  of  venereal  disease  and  the 
sanity,  healthfulness,  and  safety  of  sexual  control  and 
continence.  Recruiting  officers  can  do  much  by  careful 
selection  of  men,  as  it  is  a  well-known  fact  that  the 
great  number  of  admissions  to  sick  report  for  venereal 
disease  is  made  up  by  a  relatively  small  number  of  men, 
the  majority  of  whom  are  of  the  less  desirable  class  of 
soldiers.  Drink,  poor  home -training,  ignorance,  and 
lack  of  self-respect  lead  these  men  to  places  and  prac- 
tices that  their  more  decent  comrades  avoid. 

As  man  is  the  only  carrier  of  these  diseases,  as  they 
are  transmitted  in  nearly  all  instances  by  direct  physi- 
cal contact,  and  as  early  diagnosis,  isolation,  and  treat- 
ment enable  us  to  do  much  in  the  control  of  other 
transmissible  diseases,  it  seems  reasonable  to  believe 
that  similar   measures,   if  generally   enforced,  would 


VENEREAL  DISEASES  315 

produce  great  results  in  these.  There  can  hardly  be 
any  doubt  that  if  all  cases  of  venereal  disease  were 
promptly  reported  and  then  isolated  and  kept  from 
sexual  intercourse  until  well,  the  diseases  would  be  ex- 
terminated. These  are  such  chronic  troubles,  however, 
and  require  such  prolonged  and  careful  treatment  to 
insure  a  cure,  that  such  a  plan  is  quite  impracticable. 
Many  efforts  have  been  made  to  approach  it  though, 
by  the  regular  examination  of  prostitutes  and  their 
isolation  and "  treatment  until  free  from  contagious 
lesions,  and  similar  measures  have  been  adopted  in  re- 
gard to  soldiers  in  our  own  service.  But  it  cannot  be 
said  that  the  diseases  have  been  brought  under  control 
by  such  measures,  and  the  reasons  are  fairly  obvious. 
It  is  practically  impossible  for  an  examiner  to  know 
positively  that  a  given  person  is  free  from  venereal 
disease.  Chancroids  are  easy  of  detection,  but  both 
syphilis  and  gonorrhoea  may  linger,  capable  of  trans- 
mission, without  giving  any  indications  of  their  presence 
that  can  be  detected  by  the  inspection  that  the  exam- 
iner of  large  numbers  can  give.  This  is  true  in  the  case 
of  soldiers,  and  much  more  so  in  that  of  prostitutes, 
who,  moreover,  are  adept  in  the  removal  of  slight  signs 
that  may  be  present,  and  whose  interest  lies  in  escaping 
isolation.  Most  prostitutes  are  such  for  one  of  two 
reasons,  either  for  the  pleasure  and  excitement  they 
find  in  the  life  or  for  the  money  they  can  make  out  of  it. 
In  either  case  their  object  is  defeated  for  the  time  be- 
ing if  they  are  isolated.  Furthermore,  there  is  always 
and  everywhere  a  large  amount  of  clandestine  prostitu- 
tion, that  is,  that  practiced  by  women  not  openly  pro- 
fessing to  do  so ;  and  as  registration  of  the  prostitute 
is  a  necessary  preliminary  of  her  regular  examination. 


316       THE  PREVENTION   OF  EPIDEMICS 

a  large  amount  of  venereal  disease  thus  escapes  detec- 
tion. Naturally,  too,  the  amount  of  this  clandestine 
prostitution  increases  with  the  severity  and  strictness 
of  the  measures  of  control  over  that  which  is  licensed. 
As  examinations  are  not  usually  made  more  than  once 
a  week,  and  in  many  instances  not  so  often,  a  woman 
may  develop  a  contagious  discharge  or  sore  the  day 
after  examination,  and  transmit  disease  to  fifty  men  be- 
fore being  examined  again.  A  prostitute  living  near  a 
Western  post  stated  that  she  usually  hiad  intercourse 
with  from  fifteen  to  twenty-five  men  on  the  night  fol- 
lowing payment  of  the  troops,  and  with  from  one  to  five 
or  six  men  on  other  nights,  and  investigations  in  Chi- 
cago, New  York,  and  elsewhere  have  since  shown  that 
that  is  no  unusual  record  for  a  prostitute. 

American  sentiment  has  never  favored  state  licens- 
ing of  prostitution.  Without  discussing  the  right  and 
wrong  of  the  matter,  we  must  face  the  following  con- 
dition as  regards  the  army.  It  consists  of  aggregations 
of  men,  mostly  young,  mostly  unmarried,  and  largely 
ignorant,  who  have  abundant  opportunity  to  gratify 
their  sexual  instincts,  but  with  women  who  are  under 
little  or  no  control,  many  of  whom  are  diseased,  and 
all  of  whom  are  interested  in  avoiding  treatment  that 
involves  isolation.  The  obvious  courses  of  procedure 
are,  1st,  the  provision  of  wholesome  surroundings  and 
amusements  to  keep  the  men  away  from  dives  and  bro- 
thels ;  2d,  their  instruction  as  to  the  nature  and  dangers 
of  the  venereal  diseases,  so  that  the  large  amount  of 
these  due  to  ignorance  may  be  eliminated  ;  3d,  advice 
as  to  the  best  methods  of  avoiding  disease  in  case  they 
are  so  persistently  foolish  as  to  expose  themselves  to 
it.    The  instruction  as  to  the  nature  and  danger  of  the 


VENEREAL  DISEASES  317 

venereal  diseases  may  be  derived  from  the  following 
consideration  of  them. 

Gonorrhoea 

Gonorrhoea  or  "  clap"  is  a  disease  of  such  great  an- 
tiquity that  it  may  be  as  old  as  prostitution  itself,  and 
the  first  half  of  the  fifteenth  chapter  of  Leviticus  indi- 
cates that  Moses  knew  it  and  also  knew  that  it  was 
conveyed  by  contact,  and  that  he  provided  rules  to  pre- 
vent its  spread. 

The  disease  is  due  to  a  bacterium  known  as  the  gono- 
coccus.  This  organism  occurs  constantly  in  the  gonor- 
rhceal  discharge,  and  the  disease  can  be  pro-  -^ 
duced  by  artificial  inoculation  with  it.  It 
is  very  hard  to  cultivate  artificially,  and  is  readily  de- 
stroyed by  drying,  heat,  and  antiseptic  drugs.  It  may 
live  for  some  time  on  towels  or  linen,  or  in  warm  water. 
It  grows  on  mucous  membranes,  and  those  of  the  gen- 
ital and  urinary  passages,  of  the  eyes,  mouth,  and  rec- 
tum may  be  affected. 

The  young  are  more  susceptible  to  its  action  than 
the  old,  and  children  are  particularly  easy  of  infec- 
tion.   The  disease  once  started  in  hospitals     j» «« 
for  children  or  in  orphan  asylums,  espe- 
cially  among  little  girls,  is  apt  to  become  epidemic. 

Transmission  is  usually  by  sexual  contact,  but  it  may 

occur  through  mediate  transfer,  as  by  towels,  soiled 

hands,  penis  syringes,  or  urethral  sounds.     irirflTia 

Such  methods  are  uncommon,  however,  and 

mission 
little  credence  can  be  placed  in  the  story  of 

the  man  who  thinks  he  got  it  from  a  water-closet  seat. 
Strain,  as  from  heavy  lifting,  can  never  cause  the  dis- 
ease, though  often  alleged  to  do  so. 


318       THE  PREVENTION  OF  EPIDEMICS 

The  incubation  period  varies  considerably,  and  the 
disease  may  manifest  itself  within  a  day  of  the  impure 
_       -  connection  or  it  may  not  do  so  for  ten  or 

^  twelve  days,  or  for  some  intervening  period. 

It  usually  begins  with  slight  burning  on 
urination,  which  leads  the  subject  to  examine  his  penis, 
when  he  may  find  the  margins  of  the  urinary  opening 
«.^^  red  and  somewhat  puffy.  Or  the  lips  of  the 

.  opening  may  be   stuck  together  when  he 

arises  in  the  morning,  and  a  drop  of  clear 
discharge,  like  white  of  eggy  can  be  expressed  from  it. 
The  symptoms  increase  rapidly,  and  within  another  day 
or  two  the  disease  is  at  its  height.  The  discharge  is 
then  more  profuse,  is  creamy  in  color  and  consistency, 
the  penis  is  sore,  and  urination  painful.  Erections  may 
be  frequent  and  painful,  especially  when  the  patient  is 
in  bed  and  when  the  inflammation  has  extended  out 
into  the  body  of  the  penis.  These  may  cause  intense 
pain,  and  the  organ  may  be  curved.  This  condition  is 
known  as  chordee.  The  inflammation  may  extend  to 
the  bladder,  causing  very  frequent  and  painful  urina- 
tion ;  to  the  testicles,  causing  swelling,  pain,  and  some- 
times abscess  formation,  and  often  leading  to  stoppage 
of  the  duct  leading  from  the  testicle  to  the  seminal 
bladder,  and  so  rendering  the  former  useless  as  a  pro- 
creative  organ.  Germs  may  be  carried  to  the  lym- 
phatic glands  in  the  groins,  and  cause  them  to  become 
very  painful,  tender,  and  swollen,  and  oftentimes  to 
suppurate.  This  glandular  swelling  constitutes  a  bubo. 

These  various  troubles  may  cause  great  pain  and 
suffering,  but,  in  the  absence  of  further  complications, 
they  lessen  in  severity  after  a  time,  usually  from  one 
to  six  weeks,  the  swellings  subside,  the  discharge  dimin- 


VENEREAL  DISEASES  319 

ishes  or  ceases,  and  the  patient  may  think  he  is  well. 
Or  he  may  recognize  that  he  has  gleet.  This  pg-gig* 
is  a  condition  not  attended  by  other  symp-  g„«Q 
toms  than  the  presence  of  a  small,  clear  drop 
of  discharge  in  the  early  morning,  and  it  is  usually  re- 
garded as  of  no  importance.  It  is  gonorrhoea,  however, 
and  is  capable  of  setting  up  the  disease  in  others,  and 
many  unfortunate  brides  have  been  so  infected.  It  may 
persist  for  months  or  years,  and  other  manifestations 
of  the  disease  may  do  likewise.  Many  men  have  suffered 
or  died  from  the  results  of  gonorrhoea  ten,  twenty,  or 
more  years  after  they  thought  themselves  cured  of  it ; 
or,  worse  still,  they  have  seen  their  wives  or  children 
sicken,  become  blind,  or  die  as  the  result  of  it,  and  have 
had  no  thought  that  they  were  themselves  responsible 
for  the  calamity. 

The  complications  of  gonorrhoea  are  so  numerous,  so 
serious,  and  some  of  them  apparently  so  remote,  that 
there  is  no  space  to  discuss  them  here,  but  nomnli 
some  of  them  will  be  mentioned.  Stricture  ^3*1--- 
is  one  of  the  most  common.  It  is  often  pre- 
sent when  a  gleet  persists.  It  may  cause  obstruction  of 
urine,  great  suffering,  and  serious  or  fatal  kidney  disease 
years  after  the  acute  gonorrhoea.  The  principal  symptom 
is  obstruction,  usually  partial,  to  the  urinary  stream.  In- 
flammation of  the  prostate  gland  may  develop  and  last 
for  years,  causing  pain  in  urination  and  perhaps  during 
defecation,  pain  deep  between  the  legs,  marked  nervous 
symptoms,  and  general  invalidism.  Gonorrhoeal  rheu- 
matism^ or  joint  inflammation,  is  always  hard  to  treat, 
causes  great  pain,  and  tends  to  last  for  a  long  time.  It 
may  result  in  great  deformity  and  permanent  crippling. 
Tendon  inflammation  may  also  occur  and  produce  symp- 


320       THE  PREVENTION  OF  EPIDEMICS 

toms  much  like  the  joint  troubles.  Pain  and  tenderness 
of  the  heel  or  of  the  great  tendon  leading  upward  from 
it  may  result  from  gonorrhoea  and  prevent  marching. 
Mye  diseases  of  at  least  two  kinds  result  from  this  dis- 
ease and  always  endanger  and  frequently  destroy  the 
sight.  Gonorrhoea  is  one  of  the  great  causes  of  blind- 
ness, the  disease  often  developing  in  children  at  the 
time  of  birth,  from  infection  entering  their  eyes  from 
their  mothers'  genitals,  the  mothers  often  being  infected 
by  their  husbands,  who  thought  themselves  cured  before 
marriage.  The  disease  may  also  be  conveyed  to  the  eyes 
by  the  hands  after  urinating  or  wiping  away  discharge 
from  the  penis.  It  may  be  transferred  from  one  person 
to  another  through  the  medium  of  towels,  wash-cloths, 
medicine-droppers,  and  other  things  in  common  use. 
Blood-poisoning,  that  is,  the  diffusion  of  germs  through 
the  blood,  may  result  from  gonorrhoea  and  may  cause 
death.  Heart  disease  may  be  a  complication,  and  often 
accompanies  blood-poisoning.  It  may  cause  death  early 
or  may  be  apparently  recovered  from,  and  the  heart 
may  break  down  from  the  damage  done  it  only  after 
the  lapse  of  years.  Owing  to  the  levity  with  which  the 
disease  is  often  regarded,  this  complication  may  not  be 
detected  at  the  time  of  its  occurrence. 

As  already  stated,  the  subject  of  gonorrhoea  is  a 
source  of  danger  to  his  companions  and  his  family,  and 
—  in  military  life  it  is  desirable  that  he  should 

^,  be  confined  to  hospital,  at  least  during  the 

time  of  most  active  symptoms,  and  that  all 
men  should  be  cautioned  against  using  the  towels  or 
linen  belonging  to  others.  No  man  worthy  the  name 
would  deliberately  infect  another  person  with  his  dis- 
ease, but  many  men  unintentionally  do  so.    All  should 


VENEREAL   DISEASES  321 

be  instructed  to  abstain  from  sexual  intercourse  until 
entirely  cured. 

Without  condoning  or  attempting  to  justify  illicit  in- 
tercourse, we  must  recognize  that  many  men  will  indulge 
in  it  in  spite  of  instruction,  warning,  and  ^ 
example,  and  it  is  the  part  of  economy  and  ^ 
makes  for  the  efficiency  of  the  army  if  those 
men  can  be  protected  from  disease  in  spite  of  their  folly 
and  misconduct.  No  infallible  means  of  protection  from 
venereal  contamination  is  known  except  chastity,  but  the 
following  measures  may  ofPer  some  degree  of  it.  Urina- 
tion^ if  practicable  immediately  after  intercourse,  tends 
to  wash  out  germs  that  may  have  entered  the  urethra. 
Irrigation  of  the  urethra  with  a  mild  antiseptic  solution, 
such  as  permanganate  of  potash  solution  in  strength  of 
one  part  to  three  thousand,  has  a  similar  action.  The  use 
after  intercourse  of  jellies  or  ointments  containing  anti- 
septic or  anti-gonorrheal  drugs  put  up  in  collapsible 
tubes  has  become  rather  common,  because  of  the  porta- 
bility and  convenience  of  these  as  compared  with  irri- 
gations. The  substances  usually  relied  on  in  these  pre- 
parations are  protargol  or  other  silver  preparations, 
carbolic  acid,  and  calomel.  These  preparations,  of  which 
the  K  packet  is  best  known,  are  sold  under  various  trade 
names,  and  most  of  them  are  fairly  efficacious.  Modera- 
tion in  intercourse  is  advisable.  Repeated  intercourse 
in  the  space  of  a  few  hours  brings  about  a  congestion 
of  the  genitals  which  is  slow  in  subsiding  and  which 
predisposes  to  infection.  Condoms^  impermeable  rub- 
ber coverings  for  the  penis,  are  sold  and  used  for  the 
prevention  of  disease,  and  they  should  protect  against 
gonorrhoea. 

After  the  disease  is  once  contracted  the  best  way  to 


322       THE  PREVENTION  OF  EPIDEMICS 

prevent  complications  is  by  rest  in  bed  and  proper  treat- 
p  ment.  Soldiers  should,  therefore,  be  taught 

^  ,         to  report  early  for  treatment,  and  to  con- 

-,         ,.        tinue  at  it  until  entirely  cured,  to  be  cleanlv 
^  m  their  habits,  and  by  frequent  hand-wash- 

ing and  care  of  towels  and  linen  to  avoid 
infecting  the  eyes,  and  (very  important)  to  avoid  con- 
sultation with  advertising  quacks  or  the  use  of  adver- 
tised medicines,  both  of  which  are  fraudulent. 

Chancroid 

Chancroid,  soft  chancre  or  soft  sore,  is  the  least  im- 
portant of  the  diseases  here  discussed,  as  it  is  a  local  in- 
fection and  does  not  do  the  general  damage  or  assume 
the  manifold  and  insidious  forms  that  often  characterize 
gonorrhoea  or  syphilis. 

The  typical  and  usual  soft  chancre  is  due  to  a  small 
^  bacillus  which  bears  some  resemblance  to 

that  causing  plague,  but  ulcers  may  be  pro- 
duced on  the  penis,  as  elsewhere,  by  other  organisms. 

The  incubation  period  varies  from  one  to  ten  days, 
and  its  length  probably  depends  on  a  number  of  fac- 
_       .  tors,  such  as  the  degree  of  infection  in  the 

^  woman,  the  presence  and  size  of  scratches 

or  abrasions  on  the  penis,  and  the  violence, 
length,  and  frequency  of  the  infective  intercourse. 

The  disease  begins  as  a  small  ulcer,  or  sore,  which 
may  be  no  larger  than  the  head  of  a  pin.  The  favorite 
a—--  location  is  in  the  depression  or  groove  just 

.  back  of  the  head  of  the  penis,  though  it 

may  be  anywhere  on  that  organ.  Many 
sores  may  show  at  once,  or  one  may  appear  at  first  and 
others  develop  later.     The  ulcer  enlarges  and  deepens. 


VENEREAL  DISEASES  323 

the  surrounding  parts  are  red,  swollen,  and  tender,  and 
the  surface  of  the  sore  more  so.  A  thin  and  usually 
moderate  discharge  is  present,  and  is  highly  infectious, 
and  its  presence  causes  the  development  of  the  sec- 
ondary sores.  Under  proper  treatment  the  ulcers  can 
usually  be  healed  in  a  few  days  or  weeks,  but  if  neg- 
lected or  improperly  treated  or  in  inaccessible  positions, 
they  may  spread  and  produce  considerable  loss  of  tis- 
sue, half  or  more  of  the  head  of  the  penis  being  some- 
times destroyed.  The  base  of  the  ulcer,  if  not  irritated, 
is  usually  soft  as  compared  with  the  base  of  the  syphil- 
itic chancre,  hence  the  name  soft  chancre.  Occasionally 
this  sore  may  appear  on  the  bag,  on  the  lower  hairy 
part  of  the  abdomen,  or  anywhere,  in  fact,  that  the 
virus  has  entered  the  skin. 

The  most  frequent  complication  is  bubo,  which  oc- 
curs in  about  one  fourth  of  all  cases.    It     -,         .. 
is  very  painful,  causes  lameness,  fever,  and         ^ 
may  require  operation. 

The  methods  mentioned  as  tending  to  protect  from 
gonorrhoea   are   equally  applicable  here,  except   that 
irrigation  would  not  be  particularly  valu-     ~ 
able,  as  the  sore  usually  develops  exter-     ^ 
nally  rather  than  in  the  urethra.    Washing 
the  genitals  in  an  antiseptic  solution,  such  as  one  to 
one  thousand  bichloride,  will  offer  a  certain  amount 
of  protection.    Early  and  proper  treatment  is  required 
to  produce  speedy  healing  and  lessen  the  tendency  to 
the  formation  of  buboes,  and  soldiers  should  report 
promptly  for  it. 

Syphilis 

There  has  been  much  speculation  and  discussion  as 
to  whether  syphilis,  or  pock,  originated  in  the  old 


324       THE  PREVENTION  OF  EPIDEMICS 

world  or  the  new,  whether  the  Spaniards  brought  it  to 
America,  or  took  it  from  here.  At  any  rate,  the  dis- 
ease spread  throughout  Europe  in  the  century  follow- 
ing Columbus's  voyages,  and  it  has  prevailed  through- 
out the  world  until  the  present  time,  and  is  now  seen 
in  all  ranks  of  society  and  all  walks  of  life.  It  is  the 
most  dreadful  of  the  diseases  considered  in  this  chap- 
ter because  of  its  chronicity,  the  long  time  required 
for  its  treatment,  the  great  variety  of  its  manifestations, 
the  number  and  seriousness  of  the  conditions  resulting 
from  it,  and  the  fact  that  it  is  the  disease  affording  the 
most  striking  examples  of  the  sins  of  the  fathers  being 
visited  upon  the  children.  The  disease  cannot  be  de- 
scribed or  adequately  discussed  in  the  space  allotted  here, 
but  a  very  brief  outline  of  it  will  be  given,  in  order  to 
enable  the  line  officer  to  impart  some  degree  of  informa- 
tion about  it  to  his  men. 

Although  the  disease  has  been  known  and  industri- 

^  ously  studied  for  centuries,  it  is  only  lately 

that  its  cause  has  been  known.    This  is  the 

very  fine  and  delicate  spiral  organism  mentioned  in  a 

preceding  chapter  as  a  Treponema. 

The  commonest  method  of  transmission  of  syphilis  is 

through  sexual  intercourse,  and  this  is  especially  true 

_  as  regards  soldiers,  to  whom  many  of  the 

.     .  other  avenues  of  infection  are  not  open. 

mission      -r»  .  .1  1      ,  1   , 

xJut  there  are  such  other  avenues  and  they 

are  numerous ;    and  innocent  victims  of  this  disease 

are  therefore  more  numerous  than  those  of  gonorrhoea 

or  chancroid.    Among  such  methods  we  may  mention 

the  following:  — 

Heredity.  The  disease  may  be  inherited  from  either 

parent,  and  may  infect  the  child  in  the  womb  and  cause 


VENEREAL  DISEASES  326 

its  death  there,  cause  it  to  be  born  diseased,  or  to  be 
born  apparently  well  and  develop  the  disease  soon  after. 
Or,  in  rare  cases,  it  may  be  born  apparently  well  and 
continue  fairly  so  for  years,  and  only  show  the  disease 
in  recognized  form  when  it  reaches  the  age  of  puberty. 

Contact^  especially  such  as  kissing,  is  a  fairly  common 
method  of  transmission.  Ulcers  or  sores  in  the  mouth 
are  a  common  manifestation  of  the  disease,  and  in  such 
cases  the  organisms  are  present  and  sometimes  numer- 
ous there.  The  saliva  or  discharge  from  such  a  mouth 
is  highly  infectious,  and,  if  brought  in  contact  with  a 
slight  scratch  or  sore,  will  give  rise  to  the  disease.  Chil- 
dren and  girls  have  many  times  been  infected  by  kissing 
persons  so  affected,  and  syphilitic  children  may  by  this 
means  infect  the  nipples  of  their  wet  nurses.  For  this 
reason,  also,  the  spoons,  cups,  and  other  eating  uten- 
sils and  pipes  or  cigarette-butts  that  have  been  used  by 
syphilitics,  are  dangerous.  The  blood  and  discharges 
from  sores  on  syphilitic  persons  are  infectious,  and 
nurses  and  doctors  are  occasionally  infected  in  dress- 
ing or  operating  upon  such  cases.  Several  instances 
of  the  kind  have  occurred  in  the  army.  Barbers  may 
receive  infection  if  they  get  wounds  or  scratches  con- 
taminated by  the  saliva  or  blood  of  their  patrons, 
and  they  may  also  transmit  it  through  scratches  or 
cuts.  Dentists  and  their  implements,  if  not  clean,  may 
transmit  it. 

The  incubation  period  of  syphilis,  the  time  inter- 
vening between  the  infective  intercourse  and  the  first 

manifestations  of  the  disease,  is  long.    It     _ 

,       ,  1        .  n  Incuba- 

is  never  less  than  ten  days,  is  usually  nearer 

a  month,  and  not  very  rarely  it  may  be  two 

months  or  more  before  the  chancre  shows,  while  in  a 


326       THE  PREVENTION  OF  EPIDEMICS 

considerable  proportion  of  infections,  probably  some- 
thing between  a  tenth  and  a  fourth,  the  chancre  does 
not  show  at  all  and  a  condition  of  latent  syphilis  exists. 
In  such  cases  it  may  be  many  years  before  any  mani- 
festation of  the  disease  is  recognized.  As  a  rule,  how- 
ever, the  incubation  period  is  from  two  weeks  to  one 
month,  after  which  time  the  primary  sore  or  chancre 
develops  at  the  point  of  entrance  of  the  virus.  This  fact 
may  be  of  value  in  determining  the  manner  of  infection. 
If  the  chancre  be  on  the  genitals,  it  is  usually  a  result 
of  sexual  intercourse ;  if  elsewhere,  the  case  may  be 
different.  It  may  be  on  any  part  of  the  body,  as  on  the 
top  of  the  head  or  the  ear,  where  it  has  been  seen  to 
result  from  bites  received  in  fighting ;  inside  the  rectum 
as  a  result  of  unnatural  practices ;  on  the  breast  of  a 
wet  nurse ;  or  on  the  arm  of  a  child  vaccinated  with 
virus  from  a  syphilitic. 

The  chancre  constitutes  the  first  sign  of  the  disease. 
It  appears  first  as  a  small  firm  lump  resembling  a  pim- 
_  .  pie.  This  may  enlarge  considerably  or  not 

« .  at  all,  depending  somewhat  on  its  situation. 

It  usually  ulcerates  slightly  at  its  top,  and 
shows  a  slight  discharge,  which  may  be  thin  and  clear, 
or  purulent.  The  chancre  is  nearly  always  single,  and 
secondary  ones  rarely  develop.  Its  base  is  usually  hard 
and  firm  and  feels  like  cartilage  or  even  like  bone,  hence 
this  is  called  the  hard  chancre.  It  may  be  so  small  as 
not  to  be  noticed,  and,  as  the  patient  may  continue  feel- 
ing well  while  he  has  it,  he  may  not  know  that  he  is 
diseased  until  the  appearance  of  secondary  symptoms 
after  another  period  of  six  to  twelve  weeks.  It  is  not 
rare  to  have  soldiers  appear  with  well-marked  second- 
ary signs  of  the  disease  and  no  chancre,  and  denying 


VENEREAL  DISEASES  327 

that  they  have  had  any.    The  secondary  symptoms  are 
usually  plainly  marked  and  lead  the  patient     «  , 

to  seek  treatment.  They  are  referred  par- 
ticularly to  the  skin  and  mucous  mem-  « 
branes,  and  the  most  common  of  them  are 
skin  eruptions,  sores  in  the  mouth  and  throat  and 
about  the  anus,  falling  of  hair,  slight  fever,  pains  in 
the  bones  or  joints,  anemia  and  pallor,  and  various 
eye  troubles.  The  skin  lesions  of  syphilis  are  so  nu- 
merous and  of  such  varied  character  that  it  has  been 
said  that  they  can  simulate  all  other  skin  diseases. 
The  arteries,  heart,  and  internal  organs  may  also  be 
affected  in  the  secondary  stage.  In  fact,  no  other 
known  disease  manifests  itself  in  so  many  ways  as 
this  one,  and  it  simulates  the  greatest  variety  of  af- 
fections, including  smallpox  and  other  eruptive  dis- 
eases, malaria,  liver  abscess,  tuberculosis  of  lungs, 
bones,  or  joints,  epilepsy,  and  very  many  more.  It  is, 
therefore,  obviously  out  of  the  question  even  to  mention 
most  of  the  symptoms  here. 

This  stage  may  not  manifest  itself  if  the  case  is  well 
treated  in  the  primary  and  secondary  stages.    Other- 
wise it  may  merge  with  the  secondary,  or  it     rn^j^a 
may  appear  only  after  the  lapse  of  years,     gta^e 
It  is  characterized  by  deeper  skin  lesions, 
that  show  a  tendency  to  ulcerate  and  form  large  and 
deep  sores,  by  destruction  of  bone,  the  formation  of 
swellings  or  tumors,  and  the  degeneration  of  internal 
organs.     Tertiary  syphilis  is  more  often  mistaken  for 
tuberculosis,  cancer,  and  other  chronic  ailments,  than 
for  more  acute  ones.    The  syphilitic  tumors  may  form 
in   any   part   of   the   body,  and  those  in   the   brain, 
heart,  spinal  cord,  and  other  vital  parts  may  be  rapidly 


328       THE  PREVENTION   OF  EPIDEMICS 

fatal.  Syphilis  is  the  most  common  cause  of  aneu* 
risin. 

A  large  and  important  part  of  the  harm  done  by  syph- 
ilis was  long  not  charged   to   that  disease,  and  it  is 
only  comparatively  recently  that  we  have 
^*'  had  the  proof  that  enables  us  to  know  the 

^,  terrible  extent  of  its  ravages  on  the  nervous 

Nervous  ,  t>    •     •  vu  j 

system.    rJegmning  with  nervousness  and 

^  neurasthenia,  that  may  appear  early  in  the 

disease  and  completely  destroy  the  happiness  and  com- 
fort of  the  patient  and  his  family,  the  number  of  cases 
of  disease  of  the  nervous  system  due  to  it  is  very  large 
indeed,  and  embraces  a  great  variety  of  manifestations. 
Among  these  may  be  named  many  varieties  of  paraly- 
sis, muscular  atrophy,  many  chronic  headaches,  about 
one  fourth  of  all  cases  of  insanity,  all  cases  of  general 
paralysis  or  paresis,  probably  all  locomotor  ataxia,  and 
many  of  blindness  and  brain  tumor. 

Syphilis  is  transmissible  in  any  of  its  stages ;  highly 
so  in  the  first,  more  so  in  the  second,  and  but  slightly 
«j     .    ,         in  the  third.    The  time  of  greatest  danger 
,  p  is  that  during  which  there  are  sores,  with 

open  moist  surfaces,  in  the  mouth,  the  nose, 
on  the  genitals,  and  about  the  anus ;  and 
it  is  advisable,  in  military  service,  to  con- 
fine in  hospital  men  who  present  such  lesions.  At  other 
times,  if  they  are  kept  under  observation  by  a  medical 
officer  and  continue  their  treatment,  they  may  safely 
mingle  with  their  fellows  and  do  full  duty. 

A  large  proportion  of  syphilitic  cases  are  inade- 
quately treated  and  remain  uncured  because  of  the  very 
general  tendency  of  patients  to  neglect  treatment  or  to 
stop  it  entirely  as  soon  as  they  are  free  from  discom- 


VENEREAL   DISEASES  329 

fort  and  from  disfiguring  lesions.  The  disease  may,  in 
rare  instances,  be  cured  by  a  single  dose  of  salvarsan  or 
neosalvarsan,  but  in  the  majority  of  cases    _  , 

that  is  not  so,  and  treatment  must  be  con-  r  m 
tinued  for  a  period  of  months  or  years. 
Even  when  brought  under  temporary  con- 
trol and  apparently  cured,  the  disease  may  still  exist 
and  merely  be  latent,  to  manifest  itself  later  in  the  form 
of  aneurism,  locomotor  ataxia,  insanity,  or  some  obscure 
trouble.  There  is  much  evidence  to  show  that  different 
strains  of  the  Treponema  tend  to  localize  in  different 
tissues,  one  strain  in  the  skin,  for  instance,  another  in  the 
blood  vessels,  another  in  the  nervous  system.  This  cor- 
responds to  the  observed  fact  that  many  cases  of  aneu- 
rism, locomotor  ataxia,  and  general  paralysis  are  to  be 
found  in  persons  who  had  few,  slight,  or  no  skin  lesions 
with  their  syphilis.  It  is  therefore  very  important  that 
the  continuance  and  energy  of  treatment  should  not 
be  allowed  to  depend  on  the  mere  presence  or  absence 
of  skin  lesions,  and  that  other  means  of  determining 
whether  the  disease  exists  should  always  be  used.  Of 
such  other  means  the  Wasserniann  test  is  now  most 
widely  known  and  most  generally  effective.  Treatment 
should  be  continued  until  that  test  becomes  negative  and 
remains  negative  for  some  months.  The  test  should  be 
repeated  at  intervals  of  about  six  months  for  two  years 
after  treatment  has  been  discontinued,  and  in  the  event 
of  the  test  showing  a  recurrence,  treatment  should  be 
resumed.  When  a  man  has  been  free  from  symptoms  of 
disease  and  has  had  a  negative  Wassermann  reaction  for 
two  years  it  may  be  considered  safe  for  hira  to  marry, 
thoTigh  it  must  be  borne  in  mind  that  there  is  even 
then  a  chance  of  his  developing  symptoms  later. 


330       THE  PREVENTION  OF  EPIDEMICS 

The  special  preventive  measures  that  may  be  em- 
ployed by  men  exposing  themselves  to  the  dangers  of 
_  polluted  intercourse  are  the  same  as  were 

^  mentioned  for  gonorrhcea  and  chancroid.  A 

small  amount  of  experimental  and  clinical 
evidence  also  indicates  that  protection  may  be  conferred, 
in  at  least  some  instances,  by  the  use  of  a  calomel 
ointment.  This  is  thirty  per  cent  calomel  in  lanolin,  and 
should  be  well  rubbed  into  the  penis  and  exposed  parts 
for  from  five  to  twenty  minutes,  at  the  conclusion  of 
the  intercourse  and  after  the  use  of  the  irrigation  and 
wash  mentioned  as  preventive  of  gonorrhoea  and  chan- 
croid. 

Mixed  Infections 

One  may  be  simultaneously  infected  with  two  or  all 
of  the  venereal  diseases,  and  in  such  instances  the  more 
quickly  developing  gonorrhoea  or  chancroid  masks  the 
presence  of  the  chancre,  and  great  surprise  may  result 
when  the  secondary  symptoms  of  syphilis  become  mani- 
fest. Occasionally  the  chancre  develops  inside  the 
urethra  and  occasions  a  slight  discharge  which  may  be 
mistaken  for  gonorrhoea,  or  the  latter  disease  may  co- 
exist. In  either  event  the  chancre  may  be  overlooked. 
More  frequently,  however,  the  confusion  arises  from 
the  coexistence  of  soft  and  hard  chancres.  It  is  gener- 
ally believed  by  men  having  venereal  sores  that  the  soft 
sore  is  never  syphilitic,  and  that  it  always  arises  within 
ten  days,  while  the  hard  chancre  is  always  syphilitic, 
and  never  appears  within  ten  days.  These  are  usually 
true  as  related  to  pure  single  infections.  But  the  viruses 
of  soft  chancre  and  of  syphilis  may  both  enter  the  skin 
at  the  same  point,  in  which  case  a  soft  and  ulcerating 


VENEREAL  DISEASES  331 

sore  may  develop  early  and  be  followed  by  a  large 
suppurating  bubo,  a  thing  not  occurring  in  pure  syph- 
ilis, and  may  heal  under  local  treatment,  leaving  no 
induration,  or  only  a  slight  one  that  is  ascribed  to  inflam- 
mation. The  syphilitic  virus  nevertheless  continues  its 
work  and  in  due  time  the  secondary  symptoms  develop. 
Some  soft  sores,  especially  those  burned  with  acids,  have 
a  base  of  inflammatory  tissue  that  may  greatly  resemble 
the  hard  base  of  the  syphilitic  sore. 

So  difficult  is  the  differentiation  of  syphilitic  from 
non-syphilitic  venereal  sores,  by  the  appearance  alone, 
that  most  careful  practitioners  do  not  definitely  decide 
that  a  given  sore  is  syphilitic,  and  therefore  do  not 
begin  constitutional  treatment  until  the  diagnosis  is 
made  by  the  finding  of  the  Treponema,,  by  a  positive 
Wassermann  reaction,  or  by  the  occurrence  of  second- 
ary symptoms.  These  things  appear  in  the  order  named, 
and,  as  it  is  important  that  treatment  should  begin  as 
early  as  possible,  they  are  for  this  purpose  valuable 
in  the  same  order. 


SUPPLEMENT 

THE  PREVENTION  OF 
MENTAL  AND  NERVOUS  DISEASES 


CHAPTER  XVI 

THE  PREVENTION   OF  MENTAL  AND  NERVOUS 
DISEASES 

The  amount  of  inefficient  army  service  and  the  num- 
ber of  discharges  because  of  insanity  and  nervous  dis- 
eases are  sufficiently  great  to  justify  and  to  demand  a 
brief  discussion  of  those  troubles  and  of  what  may  be 
done  by  the  officer  or  enlisted  men  to  prevent  or  avoid 
them.  For  this  reason  the  main  factors  influencing 
their  occurrence  will  be  mentioned  and  the  preventive 
measures,  so  far  as  such  are  known,  pointed  out  or  made 
self-evident. 

The  Predisposing  Causes 

Bad  heredity  is  probably  the  largest  single  factor  in 
the  causation  of  these  diseases,  and  it  is  manifestly  the 
one  over  which  society  in  general  has  least 
influence  and   the  person  inheriting   has  ^ 

none. 

We  may  say  of  heredity,  though,  that  it  is  not  always 
damning  in  its  influence;  a  good  many  normal  persons 
and  a  considerable  proportion  of  brilliant  ones  are  of 
stock  that,  from  a  biological  standpoint,  can  only  be 
considered  bad.  At  the  same  time  many  persons  who 
do  show  the  evil  effects  of  bad  inheritance  are  not  neces- 
sarily insane,  epileptic,  or  useless  because  of  "  nervous- 
ness," but  they  stand  closer  to  the  stage  of  incapacity 
than  do  normal  folk,  are  more  heavily  handicapped  in 


336  THE   PREVENTION  OF 

the  race  of  life,  and  lie  under  the  greater  necessity  for 
guarding  themselves  from  evil  influences. 

Heredity  is  a  factor  in  most  of  the  disabling  func- 
tional disorders  of  the  nervous  system,  including  the 
two  major  groups  of  insanity,  known  as  dementia  pre- 
cox and  manic-depressive  insanity,  epilepsy,  hysteria, 
and  nervous  instability,  and  those  stoppages  of  develop- 
ment that  result  in  the  states  known  as  imbecility  and 
"cussedness,"  all  of  which  ai-e  found  in  the  army. 

Education,  its  lack,  or  the  improper  direction  of  it, 
exercises  a  very  great  influence  on  the  development  of 
mental  and  nervous  diseases.  It  acts  first 
by  leading  directly  to  the  formation  of 
proper  habits  of  thought  and  conduct,  and, 
secondly,  by  imparting  a  degree  of  knowledge  that  dis- 
sipates, or  tends  to  dissipate,  the  ignorance  in  which 
false  beliefs,  groundless  fears,  and  misdirected  enthusi- 
asms flourish.  The  earlier  proper  measures  of  education 
are  undertaken,  the  more  effective  they  are  in  accom- 
plishing the  great  and  important  result  of  teaching  the 
individual  moderation  and  self-control,  and  many  a 
spoiled  or  incorrigible  child  becomes  a  less  useful  citizen, 
or  passes  to  the  congregation  of  the  incompetents,  for 
lack  of  the  loving  but  firm  and  wise  parental  training 
that  every  child  is  entitled  to  and  should  get.  "  He  that 
ruleth  himself  is  better  than  he  that  taketh  a  city," 
but  his  chances  of  ever  doing  either  are  not  very  good 
unless  he  be  taught  early  to  rule  himself.  The  army 
itself  is  a  great  educational  institution,  and,  though  its 
training  comes  late  and  its  methods  are  inelastic  and 
prove  harmful  to  some  of  the  unstable  ones  for  whom 
they  are  not  well  adapted,  it  disciplines  and  strengthens 
apd  makes  useful  citizens  of  quite  a  number  who  might 


MENTAL  AND  NERVOUS   DISEASES      337 

never  become  such  without  the  self-control  and  regu- 
larity of  life  they  learn  therein.  Officers  should  try  to 
make  discipline  conform  to  individual  needs,  and  should 
exercise  all  their  patience  in  getting  the  recruit  started 
in  the  right  way  of  training. 

Age  is  an  important  factor  in  determining  the  time 
of  onset  and  the  type  of  insanity.  The  type  most  fre- 
quently seen  in  the  army  is  that  known 
as  dementia  precox,  and  it  is  most  common  ° 
because  the  large  majority  of  soldiers  are  in  early  man- 
hood, the  time  at  which  it  is  particularly  apt  to  show. 
It  may  occur  as  early  as  puberty  and  occasionally  after 
the  thirtieth  year.  Another  large  group,  manic-depres- 
sive insanity,  is  particularly  apt  to  recur  from  thirty- 
five  to  fifty,  and  the  involutional  insanities,  those  due 
to  arterial  sclerosis  and  the  degenerative  processes  of 
old  age,  occur  after  fifty  as  a  rule. 

Habits  are  of  the  greatest  importance  in  the  preven- 
tion and  control  of  nervous  diseases.  Education  is  a 
failure  if  it  does  not  lead  to  the  formation 
of  good  habits,  such  as  are  helpful  to  the 
individual,  to  society,  or  to  the  race.  Habits  become 
characteristics,  characteristics  make  up  character,  char- 
acter is  what  a  man  is,  so  that  we  may  truly  say  that  a 
man  of  good  habits  has  built  his  character  and  his  very 
being  on  a  solid  foundation,  and  the  difference  between 
stability  and  instability  of  mind  and  character  may 
sometimes  be,  in  the  final  analysis,  a  difference  of  habits. 
There  are  some  habits,  however,  that  directly  lead  to 
disease  or  poisoning  that  act  as  exciting  causes  of  in- 
sanity, and  some  others  that  develop  into  characteristics 
so  constantly  found  in  insanity  that  they  may  be  con- 
sidered ^n  essential  part  of  it. 


338  THE  PREVENTION   OF 

Characteristic  of  all  insanity  is  an  intense  egotism, 
a  centering  in  self  of  all  thought  and  all  natural  phe- 
nomena, a  selfishness  that  alters  the  whole  world  or 
the  whole  universe  in  order  to  allow  it  to  act  upon  or 
for  the  individual.  Whether  he  be  exalted  or  depressed, 
a  king  or  a  worm,  God  or  the  devil,  a  Saviour  or  the 
worst  of  sinners,  he  is  at  least  the  center  of  things,  a 
tremendous  ego.  It  is  obvious  that  habits  of  thought  or 
action  that  encourage  egotism  and  selfishness,  such  as 
introspection,  disregard  of  the  rights  of  others,  undue 
sensitiveness,  suspiciousness,  seclusiveness,  brooding, 
anxiety,  and  undue  worrying  are  harmful  in  this  as  in 
other  directions.  Harmful,  also,  as  tending  to  instabil- 
ity, are  undue  love  of  excitement  and  constant  seeking 
for  variety,  change,  and  outside  amusements.  Improper 
sexual  habits,  such  as  masturbation,  sexual  perversions, 
sexual  images  of  thought,  are  harmful  in  two  ways :  by 
bringing  about  frequent  states  of  excitement,  and  by 
producing  a  mental  state  of  depression,  shame,  feeling 
of  unworthiness,  fear,  and  suspicion  that  others  may 
learn  the  facts,  all  such  as  to  upset  the  proper  self-con- 
fidence and  self-respect  so  essential  to  poise,  self-control, 
and  clear  thinking.  Habits  of  indulgence  in  drink  and 
harmful  drugs,  especially  the  former,  constitute  probably 
the  largest  single  factor  except  heredity  in  the  causation 
of  insanity,  and  will  be  discussed  later,  while  those  habits 
predisposing  to  syphilis  have  been  considered. 

On  the  other  hand,  it  may  be  stated  that  there  are 
no  greater  preventives  of  insanity  than  those  measures 
of  conduct  and  the  cultivation  of  those  virtues  which 
we  all  at  heart  recognize  as  good  and  desirable,  how- 
ever much  onr  conduct  points  to  the  contrary.  Among 
physical  habits  and  practices  thus  helpful  we  may  men- 


MENTAL  AND  NERVOUS   DISEASES     339 

tion  chastity,  regularity  of  bowels,  of  sleep,  food,  and 
exercise  of  body  and  mind,  sobriety  and  moderation  in 
general,  temperance  in  all  things,  and  total  abstinence 
from  things  known  to  be  harmful.  Among  mental  traits 
to  be  encouraged  are  a  healthy  interest  in  religion  (and 
by  "  healthy  interest "  is  meant  such  as  leads  to  unself- 
ishness, helpfulness  to  others,  faith,  hope,  charity,  and 
cheerfulness),  good  reading,  good  thinking,  broad  sym- 
pathies and  wide  interests,  and  courage.  The  amount 
of  insanity  and  of  nervous  breakdown  in  which  lack  of 
courage  or  *'  loss  of  nerve "  is  a  main  characteristic  is 
very  large. 

The  Exciting  Causes 

Easily  chief  among  the  exciting  causes  of  insanity  and 
nervous  diseases  is  alcohol.  "  It  is  a  strange  commen- 
tary upon  human  frailty  that  all  the  poisons 
which  assail  man  through  accident  and  the 
dangerous  trades  in  which  he  must  engage,  and  all  the 
poisons  which  are  elaborated  within  his  system,  as  in 
nephritis,  diabetes,  thyroidism,  and  acromegaly,  are  to- 
gether responsible  for  but  a  small  fraction  of  the  number 
of  cases  of  mental  disease  due  to  his  deliberate  ingestion 
of  one  poisonous  substance  —  alcohol."  Not  only  does 
alcohol  directly  and  alone  cause  a  large  amount  of  in- 
sanity, but  it  is  the  last  straw  that  serves  to  break  the 
suffering  and  already  weak  back  of  many  a  person 
whose  nervous  organization  is  congenitally  weak.  A  very 
large  percentage  of  cases  of  dementia  precox  and  of 
other  forms  of  insanity  first  manifest  signs  of  disturb- 
ance after  alcoholic  excitement.  Furthermore,  such  in- 
dividuals are  apt  to  be  particularly  susceptible  to  the 
influence  of  alcohol  and  to  be  disturbed  by  relatively 
small  amounts  of  it 


340  THE  PREVENTION   OF 

The  more  common  alcoholic  nervous  disturbances, 
varying  from  mere  impairment  of  will  power  to  "  tre- 
mors," "horrors,"  and  "jim-jams,"  are  unfortunately 
only  too  well  known.  As  stated  before,  the  person  in- 
heriting a  predisposition  to  nervous  unbalance  is  under 
a  heavy  handicap  and  must  take  great  care  to  avoid 
harmful  influences,  and  there  is  no  influence  that  he 
should  more  carefully  avoid  than  that  of  alcohol. 

Poisoning  by  lead,  mercury,  and  some  other  metals 
may  cause  insanity,  neuritis,  and  other  disturbances. 
Other  ^^^  frequency  and  speed  with  which  the 

~   .  habitual  use  of  morphine,  cocaine,  chloral, 

and  other  narcotic  drugs  undermine  the 
will,  the  powers  of  application,  and  the  morals  of  their 
users  and  make  nervous  wrecks  of  them  are  all  too 
familiar.  Addiction  to  such  drugs  is  akin  to  drunk- 
enness and  is  in  itself  an  evidence  of  weakened  mind 
and  disordered  nervous  system. 

The  normal  body  produces  poisons  which  it  is  ordi- 
narily able  to  get  rid  of  or  to  neutralize  without  harm 
-J    ,  to  itself,  but  when,  by  reason  of  disease, 

p   .  such  as  Bright's  disease,  diabetes,  or  cirrho- 

sis of  the  liver,  these  are  not  excreted  as  in 
normal  conditions,  or  when,  by  reason  of  other  diseases, 
as  of  the  thyroid  gland,  they  are  elaborated  either  in 
too  great  or  too  small  amounts,  nervous  disturbance  up 
to  and  including  complete  mental  upset  may  result.  It 
is  possible  that  the  poison  retention  resulting  from  mere 
constipation  might  be  influential  in  similar  directions, 
and  it  is  a  matter  of  frequent  observation  that  an  attack 
of  depression  or  of  irritability  may  be  caused  by  con- 
stipation and  relieved  by  a  purge.  The  pregnant  state 
causes  insanity  relatively  frequently,  though  whether 


MENTAL  AND  NERVOUS   DISEASES      341 

because  of  retained  poisons  or  of  disturbance  of  ductless 

glands  or  for  other  reasons  is  not  known.  Epilepsy  is 

greatly  influenced  by  the  kinds  and  amounts  of  food 

ingested  and  by  the  state  of  the  excretions,  and  there 

is  much  to  show  that  it  is  at  least  associated  with  a 

condition  of  self-poisoning. 

When  because  of   heart  disease,  arterio  -  sclerosis, 

stoppage  of  a  vessel  from  any  cause,  or  of  anemia,  the 

circulation  in  the  brain  or  the  amount  of     _.       . 

blood  carried  to  it  is  interfered  with,  it  suf-     ^ 

.    .  ,  tory 

fers,  and  the  result  is  impaired  or  disturbed     -i-j-  "1     i- 

mentality,  that  may  amount  to  actual  de- 
mentia or  insanity. 

Syphilis  is  the  only  infectious  disease  that  causes  a 
very  large  number  of  cases  of  insanity  and  of  other 
severe  forms  of  nervous  disease.  About  one 
fourth  of  all  cases  of  insanit}',  as  observed  ^^ 
in  soldiers  at  the  Government  Hospital  for  the  Insane 
and  in  civilians  at  the  Danvers  (Mass.)  State  Hospital 
and  in  a  number  of  other  institutions,  are  syphilitic; 
])robably  one  fifth  are  due  wholly  to  this  disease.  In 
addition,  as  stated  before,  all  or  practically  all  locomo- 
tor ataxia,  many  types  of  paralysis,  much  neurasthenia, 
and  a  vast  number  of  other  cases  of  nervous  disease 
are  of  the  same  origin. 

Typhus,  typhoid,  malaria,  meningitis,  pneumonia,  and 

other  infections  may  cause  insanity,  neuritis,  paralysis, 

and  other  nervous  disturbances,  but  the  f re-     -.. .      _ 

1  •  ,    ,        1         •       1  ,.    1       Other  In- 
quency  with  which  they  do  so  is  relatively     ,     ^ 

slight  as  compared  with  syphilis.  Diphthe- 
ria is  very  apt  to  canse  paralysis  of  the  throat  or  of  the 
nerves  supplying  the  heart.  Mumps  occasionally  results 
iu  deafness  from  degeneration  of  the  auditory  nerve. 


342  THE   PREVENTION  OF 

Sleeping  sickness  is  principally  a  disease  of  the  nervous 
system.  Pellagra,  though  not  definitely  known  to  be 
caused  by  infection,  has  so  many  points  of  resemblance 
to  infectious  diseases  that  it  may  be  mentioned  here. 
It  very  commonly  has  mental  disturbance  as  one  of  its 
most  striking  features. 

Injury,  especially  injury  to  the  head,  may  be  the 
direct,  exciting  cause  of  insanity,  epilepsy,  hysteria,  or 
minor  troubles.    It,  like  most  of  the  infec- 
tious diseases  mentioned,  is  more  apt  to  have 
such  effect  in  persons  prediposed  to  nervous  disturbance. 
Persons  strongly  predisposed  to  mental  trouble  may 
be  upset  by  relatively  trifling  things,  of  a  character,  as 
.  already  indicated  in  regard  to  alcohol,  in- 

fections, and  trauma,  such  as  would  not 
disturb  a  person  of  sound  nervous  consti- 
tution. Likewise  apparently  unimportant  worries,  such 
as  might  be  occasioned  by  anxiety  as  to  obtaining  or 
retaining  a  position,  by  an  unjust  accusation,  by  a  dis- 
turbing social  engagement,  or  by  a  mere  fear  of  making 
a  social  blunder,  may  act  as  a  determining  factor  in 
mental  disease.  It  may  be  readily  understood,  then,  that 
the  change  of  environment  that  occurs  on  enlistment, 
the  transfer  possibly  from  a  home  where  the  individual's 
weakness  has  been  supported,  his  peculiarities  over- 
looked, his  deficiencies  supplied,,  to  a  barracks  where 
the  men  have  no  interests  or  acquaintances  in  common 
with  him,  where  his  weakness  is  imposed  upon,  his 
peculiarities  pointed  out  and  his  deficiencies  jeered  at, 
may  prove  more  of  a  burden  than  his  weak  mentality 
can  bear.  Add  to  that  the  pangs  of  homesickness,  the 
brooding  over  the  apparent  injustice  of  disciplinary 
measures,  the  worry  incident  to  learning  drills  and  nevr 


MENTAL  AND  NERVOUS   DISEASES      343 

duties,  the  fear  excited  by  lonely  sentry  duty,  the  feel- 
ing of  isolation  caused  by  practical  jokes,  and  possibly 
the  actual  petty  tyranny  of  an  unfair  non-commissioned 
officer,  and  it  is  not  remarkable  that  weak  men  break 
down  under  it.  Later  the  real  stress  of  campaign,  the 
excitement  of  real  combat,  the  fear  caused  by  real  dan- 
ger to  life  or  limb  may  prove  the  disturbing  factor.  On 
the  other  hand,  if  the  recruit  stage  be  once  passed,  the 
man  of  poor  inheritance  may  find  in  the  army  discipline 
a  steadying  and  regulating  influence,  in  his  officers  a 
parent-like,  and  in  his  comrades  a  brotherly  control  and 
friendship,  in  his  routine  a  method  and  a  regularity, 
and  in  his  duties  an  inspiration  and  an  ideal,  which  will 
serve  to  enable  him  to  hold  to  his  mentality,  to  master 
his  fate. 


INDEX 


Abdomen,  6. 

Abstinence,  total,  encouragement  of, 
28. 

Acid,  boric,  food  preservative,  39. 

Acid,  carbolic,  antiseptic,  210;  vermin 
killer,  72;  use  of,  in  flush  closets,  63; 
for  camp  urinals,  98. 

Acids,  organic,  food  value,  35,  122. 

Actinomycosis,  transmission  of,  37. 

^robic  bacteria,  182. 

Age,  affecting  mental  and  nervous 
states,  337;  factor  in  efficiency,  4; 
incidence  of  venereal  disease,  317. 

Air,  infection  borne  by,  258;  moist,  in 
rooms,  69;  space  per  man,  56;  supply, 
as  predisposing  to  disease,  155;  value 
of,  20. 

Albuminuria,  due  to  faulty  diet,  34. 

Alcohol,  in  cold  climates,  136;  in  trop- 
ics, 125;  on  march,  28,  31;  predispos- 
ing to  disease,  157;  use  of,  exciting 
cause  of  insanity,  339. 

Alimentary  tract,  diseases  due  to  infec- 
tion through,  223. 

Amoebic  dysentery,  179. 

Anserobic  bacteria,  182. 

Anaphylaxis,  186. 

Aneurism,  due  to  syphilis,  328. 

Animal  carriers  of  disease,  191,  262. 

Animal  parasites,  168;  minute,  177. 

Ankylostomiasis.    See  Hookworms. 

Anopheles,  278;  a  man-lover,  286; 
breeding-places  of,  284;  flight  of, 
285;  salt  water,  284. 

Antelope,  reservoirs  of  sleeping  sick- 
ness, 200. 

Anthrax,  199;  transmission  of,  37. 

Antiseptics,  219. 

Antitoxin,  as  remedy  for  diphtheria, 
221;  for  prevention,  274. 

Anus,  irritation  of,  64. 

Appetite,  effect  of  cooking  on,  39l 

Auto-intoxication,  167. 

Avoidance  of  sick,  212. 

BacilU,  182. 
Bacteria,  37.  183. 


"Barbiero,"  carrier  of  Chagas'  disease, 
275. 

Barracks,  heating  of,  69;  hygiene  of, 
54;  odor,  avoidance  of,  21;  vermin 
in,  72. 

Bathing,  as  predisposing  cause  of  dis- 
ease, 158;  before  battle,  118;  by  ros- 
ter, 62;  in  camp,  83;  in  tropics,  129. 

Bathrooms,  62. 

Bathtubs,  67. 

Battlefleld,  hygiene  of,  117. 

Bedbugs,  22,  310;  and  plague,  299. 

Bedding,  airing  of,  23'. 

Bednets,  need  of,  57,  296. 

Beri-beri,  34. 

Beverages,  47. 

Bichloride  of  mercury,  antiseptic  and 
germicide,  219. 

Bill  of  fare,  weekly,  48,  50. 

Bleeders,  149. 

Blindness  from  wood  alcohol,  29. 

Body,  natural  defenses  of,  208;  resist- 
ance to  tuberculosis,  199. 

Body-poisons,  as  cause  of  insanity  and 
nervous  disease,  340. 

Body-type  and  causes  of  death,  5. 

Bowels,  regulation  of,  24. 

Breeding  places  of  mosquitoes,  286; 
destruction  of,  286. 

Brill's  disease  and  typhus,  306. 

Brush  clearing,  as  anti-mosquito  meas- 
ure, 295. 

Buboes,  16;  chancroidal,  322;  gonor- 
rhceal,  319. 

Buildings,  54. 

Butter,  45. 

Buttermilk,  45. 

Ciimp,  arrival  at,  117;  bathing  in,  83; 
change  of  site  to  shorten  epidemics, 
251;  cooking,  87;  disposal  of  human 
excrement  in,  93,  100;  fly-preven- 
tion in,  91-100;  garbage  disposal  in, 
91;  hygiene  of,  73;  incinerators,  91; 
kitchens  in,  86;  kitchen  waste,  dis- 
posal of,  89;  latrines,  93;  sanitary 
training  tat  enlisted  men  in,  101; 


346 


INDEX 


causes  of  infection  of,  76,  160;  choice 
of,  74,  75;  influence  on  health,  74,  77; 
requirements  for,  74,  75;  shelter  in, 
77;  streets  in,  78;  urinals  in,  100; 
vermin  in,  78;  water  supplies  for,  80. 

Camp-sites,  requirements  for,  74,  75. 

Cancer,  as  effect  of  smoking,  30. 

Canning,  in  food  preservation,  39. 

Cans,  garbage,  care  of,  52,  61. 

Carbohydrates,  34. 

Carriers,  contact,  229;  contaminative, 
201 ;  development  of  disease  germs  in, 
202;  food  handlers  as,  252;  healthy, 
188;  human,  187;  insect,  200,  202, 
275;  inanimate,  202;  of  cerebro- 
spinal meningitis,  188;  of  cholera, 
189;  of  diphtheria,  188;  of  disease, 
187;  of  dysentery,  189;  of  infantile 
paralysis,  188,  260;  of  influenza,  260; 
of  intestinal  worms,  189;  of  menin- 
gitis, 260;  of  scarlet  fever,  260;  of 
typhoid,  189. 

Chagas'  disease  and  "barbiero,"  275. 

Chancre,  of  syphilis,  326. 

Chancroid,  322. 

Chest,  shape,  6;  mobility,  6. 

Chewing  gum,  use  on  march.  111. 

Chicken  pox,  255;  air-borne,  266;  cause 
of,  256;  incubation  period,  265;  sec- 
ond attacks,  257. 

Chiggers  or  jiggers,  176. 

Childhood,  diseases  of,  256. 

Chlorine,  fumigation  with,  217;  to 
ptirify  water,  108;  use  in  field,  108. 

Cholera,  carriers  of,  189,  233;  cause  of, 
226;  contact  infection,  243;  control 
of  food  dealers  during  epidemics  of, 
252;  early  diagnosis  of,  245;  fly- 
borne,  239;  isolation  of  cases,  246; 
milk-borne,  236;  origin  of  epidemics, 
226;  prevention  of  epidemics,  244; 
report  of  cases,  247;  vaccination  to 
prevent,  253;  vegetable-bome,  237; 
water-borne,  234. 

Cigar  and  cigarette  smoking,  30. 

Clap.   See  Gonorrhoea. 

Cleanliness,  habits  of,  revealed  by 
linen,  17;  in  prevention  of  typhoid, 
249;  personal,  22. 

Climate,  demands  of,  as  to  clothing, 
30;  cold,  diet  in,  34,  135;  hygiene  of 
cold,  133;  hygiene  of  hot,  122. 

Clothing,  adjustment  to  needs,  30;  as 
predisposing  to  disease,  158;  chang- 
ing of,  23;  for  cold  climates,  136;  for 


marching,  113;  for  tropics,  126;  qual- 
ity of  issue,  24. 

Cocci,  182. 

Cockroaches,  as  cholera  carriers,  239. 

Coffee,  47. 

Cold,  to  preserve  meats,  38. 

Cold  climates,  air  of,  133;  clothing  in, 
136;  crowding  in,  134;  effect  of  alco- 
hol in,  136;  food  in,  135;  frost-bites, 
occurrence  of,  139;  hygiene  in,  133; 
scurvy  in,  135,  140;  shoes  for,  138; 
snow-blindness  in,  142;  ventilation 
in,  134;  water  supplies  in,  134. 

Colds,  cause  of,  20. 

Cold  storage,  to  preserve  foods,  46. 

Comma  bacillus,  in  cholera,  226. 

Condiments,  food  value,  35. 

Constipation,  45,  120. 

Contact  infection, in  childhood  diseases, 
260;  in  cholera,  243;  in  diseases  en- 
tering by  respiratory  tract,  260;  in 
typhoid,  242;  in  syphilis,  325. 

Contagion,  when  active  in  certain  dis- 
eases, 266. 

Continence,  sexual,  27,  314;  as  pro- 
moting health  of  nervous  system  ,339. 

Cooks,  company,  common  faults  of,  39; 
importance  of,  50. 

Cough,  in  recruit,  10;  tobacco,  29. 

Cresol,  solutions,  as  antiseptics,  220. 

Crowding,  dangers  of,  in  cold  climate, 
134 ;  favors  epidemics,  257. 

Culex,  283;  breeding-places,  284;  car- 
riers of  dengue  and  filariasis,  283. 

Deaths,  causes  of,  life  insurance  experi- 
ence, 5. 

Dementia  precox,  age  of  onset,  337. 

Dengue,  275,  282;  mosquito  transmis- 
sion of,  282. 

Deodorants,  use  of,  64. 

Deprivation  diseases,  168. 

Dhobie  itch,  130. 

Diagnosis,  early,  to  control  disease, 
245,  270. 

Diphtheria,  as  cause  of  paralysis,  341; 
carriers  of,  188,  255,  260;  cause  of, 
256;  incubation  period,  265;  in  dogs 
and  cats,  200;  second  attack,  257; 
when  contagious,  267. 

Discharges  from  body,  as  source  of  in- 
fection, 261;  care  of,  273. 

Disease,  carriers  of,  187;  exciting 
causes  of,  162-186;  predisposing 
causes  of,  147-160. 


INDEX 


347 


Disease  manifestations,  meaning  of, 
186;  influence  of  season  upon,  256. 

Diseases,  immunity  to,  209;  natural  de- 
fenses against,  208;  specific  remedies 
for,  220. 

Dishes,  in  transmission  of  disease,  238. 

Disinfectants,  219. 

Disinfection  in  control  of  typhoid  and 
cholera,  249;  of  various  diseases,  212; 
means  and  methods  of,  216. 

Drainage,  as  anti-mosquito  measure, 
286. 

Drains,  clogging  of,  62. 

Drying  of  foods,  46. 

Dust,  in  spread  of  disease,  238. 

Dysentery,  carriers  of,  189,  233;  causes 
of,  226;  fly-borne,  239;  milk-borne, 
236;  origin  of  epidemics,  226;  vacci- 
nation in,  253 ;  vegetable-borne,  237 ; 
water-borne,  234. 

Ears,  examination  of,  9. 

Education,  as  factor  in  mental  and 
nervous  diseases,  336. 

Emissions,  seminal,  27. 

Endotoxins,  186. 

Engineering  works,  in  prevention  of 
disease,  215. 

Environment,  influence  of,  on  develop- 
ment of  mental  and  nervous  diseases, 
342;  as  predisposing  to  disease,  154. 

Epidemics,  due  to  milk,  236;  due  to 
water,  234;  of  typhoid,  236;  origin 
of,  in  diseases  entering  by  alimentary 
tract,  226. 

Epilepsy,  341;  due  to  injury,  342;  indi- 
cations of,  11. 

Exercise,  21;  in  tropics,  123,  129. 

Exposure,  as  predisposing  to  disease, 
153. 

Eyes,  affections  of,  transmitted  by 
toilet  articles,  22;  examination  of, 
8;  infection  with  gonorrhcea,  320. 

Fats,  34. 

Feces,  disposal  in  camp,  93,  100;  dis- 
posal on  march,  116;  disposal  from 
typhoid,  cholera,  etc.,  250;  habitual 
inspection  of,  61. 

Feet,  care  of,  23,  31;  of  reoruit,  12; 
stinking,  sweating,  14. 

Filaria,  and  elephantiasis,  175;  mos- 
quito-bome,  275;  life  history  of,  174. 

Fingers,  12. 

Fires,  open,  as  aid  to  ventilation,  68. 


Fish,  61 ;  destroy  mosquito  larvse,  290. 

Flat-foot,  15. 

Fleas,  and  plague,  201,  298,  299;  life 
history  of,  299;  measures  against, 
304. 

Flies,  as  carriers  of  cholera  and  dysen- 
tery, 239;  of  typhoid,  238;  as  distrib- 
utors of  certain  diseases,  269;  flight 
of,  241;  life  history  of,  240;  preven- 
tion in  camp,  91-100;  protection 
from,  52,  59. 

Floor  room,  minimum,  56. 

Flukes,  169. 

Fomites,  in  diseases  entering  by  respi- 
ratory tract,  260;  in  typhoid-like 
diseases,  244;  most  dangerous  kinds 
of,  261;  utensils  as,  262. 

Food,  care  of,  during  epidemics,  252; 
dealers  in,  control  of,  252,  269;efifect 
of,  after  prolonged  exertion,  141; 
effect  of,  in  very  cold  clim»te9,_135; 
in  tropics,  123;  on  march.  111.     '^>v_^ 

Foods  and  preparation,  33. 

Formaldehyde  gas,  218. 

Frost-bite,  139. 

Fumigation,  to  kiU  mosquitoes,  294;  to 
prevent  disease,  217. 

Garbage,  disposal  of,  in  camp,  91. 

Garbage  cans,  care  of,  52,  61. 

Gases,  as  caxise  of  disease,  164. 

Gastric  juice,  as  defense  against  dis- 
ease. 208. 

General  paralysis,  due  to  syphilis,  328. 

German  measles,  255;  cause  of,  256; 
incubation  period,  265;  second  at- 
tacks, 257. 

Germicides,  219. 

Glanders,  carriers  of,  194. 

Gleet,  319. 

Gonorrhoea,  carriers  of,  190,  317;  dis- 
cussion of,  317-321. 

Ground-itch,  173. 

Habits,  as  predisposing  cause  of  dis- 
ease, 152;  fixity  of,  after  certain  age, 
4 ;  importance  of,  in  regard  to  nerv- 
ous and  mental  disease,  337. 

Ham,  raw,  danger  of,  39. 

Ham-bones,  in  soups,  43. 

Hammer-toe,  14. 

Hands,  care  of,  23 ;  cleanliness  for  meals, 
60;  washing  after  visit  to  toilet,  64. 

Headgear,  for  tropics,  127. 

Health  inspections,  247. 


348 


INDEX 


Heart  disease,  5;  due  to  gonorrhoea, 
320;  due  to  syphilis,  327 ;  irregularity 
due  to  tobacco,  29.- 

Heat,  in  disinfection  and  sterilization, 
216. 

Heating,  57,  59;  by  hot-air  furnace,  70; 
by  hot  water,  70;  by  open  fires  and 
stoves,  69. 

Hemorrhoids,  7,  8. 

Heredity,  and  syphilis,  322;  in  relation 
to  disease,  147;  predisposing  to  men- 
tal and  nervous  disease,  335;  trans- 
mission of  germs  by,  in  insects,  202; 
types  of,  149. 

Hernia,  7. 

Hookworms,  128,  172. 

Hydrocele,  16. 

Hydrophobia,  191;  description,  193; 
misconceptions  concerning,  192. 

Ice,  and  disease,  235. 

Ice-cheet,  52. 

Immunity,  causes  of,  211;  to  diseases, 

209;  to  malaria,  277;  varieties  of, 

209. 
Incinerators,  field,  types  of,  91. 
Incubation  period,  of  typhoid,  248;  of 

various    diseases,    265;    of    yellow 

fever,  280. 
Infantile  paralysis.    See  Paralysis,  in- 
fantile. 
Infection,  as  cause  of  insanity,  341;  in 

tropics,  122;  transmission  of,  26. 
Influenza,  discussion  of,  255-267. 
Insanity,  discussion  of,  328-342. 
Insects,  as  disease  carriers,  200,  275, 

diseases  borne  by,  275;  in  tropics, 

130. 
Internal  secretions,  disorders  of,  168. 
Intestinal  worms,  168-174. 
Investigation  of  cases,  271;  of  typhoid, 

cholera,  and  dysentery  cases,  248. 
Iodine,   as  antiseptic  and   germicide, 

220. 
Isolation,  to  prevent  spread  of  disease, 

213,  271. 
Itch,  cause  of,  176;  ground,  173;  dho- 

bie,  130. 

Jantkosoma  luUi,  as  carrier  of  fly  eggs, 
202. 

Kala-azar,  and  insects,  275. 
Kitchens,  in  camp,  86;  waste  from,  dis- 
posal of.  89;  hygiene  of,  50-60. 


Larvacide,  as  antiseptic  and  disinfect- 
ant, 220;  how  made,  291 ;  use  of,  291. 

Larvae,  infesting  man,  275;  of  mos- 
quitoes, destruction  of,  290;  screw 
worms,  176. 

Latrines,  camp,  93;  care  of,  97,  99. 

Lead  poisoning,  165;  avoidance  of,  23, 
25. 

Leprosy,  and  insects,  275. 

Lice,  and  plague,  299;  carriers  of  relaps- 
ing fever  and  typhus,  275;  diseases 
borne  by,  306;  Ufe  history  of,  307. 

Lighting,  interior,  56,  59,  67,  68. 

Lime  chloride,  63.   See  Chlorine. 

Locomotor  ataxia,  due  to  syphilis,  328. 

Limipy  jaw,  transmission  of,  37. 

Malaria,  discussion  of,  276;  parasite  of, 
discussion  of,  177;  nervous  diseases 
caused  by,  341;  prevention  of,  284; 
qmnine  as  specific  for,  221. 

Malta  fever,  transmission  of,  44. 

Manic-depressive  insanity,  age  of  on- 
set of,  337. 

Marches,  discussion  of,  103-116. 

Measles,  255;  cause  of,  256;  conta- 
giousness, 259;  incubation  period, 
265;  second  attacks,  257;  when  con- 
tagious, 266. 

Mechanical  causes  of  disease,  162. 

Meningitis,  cerebro-spinal,  255;  car- 
riers of,  188,  260;  cause  of,  256;  when 
contagious,  267. 

Mental  state,  and  syphilis,  328;  as  pre- 
disposing to  disease,  151;  effect  of, 
on  marching,  108. 

Mess,  lack  of  variety  in,  40;  manage- 
ment, books  on,  53. 

Mess-room,  59. 

Milk,  as  cause  of  epidemics,  236,  263, 
264,  269;  tuberculous,  199. 

Milk-sickness,  37,  44. 

Mites,  as  disease  carriers,  275. 

Mosquitoes,  132;  breeding-places  of, 
284,  286;  catching  of  adult,  294; 
dengue-bearing,  282;  diseases  borne 
by,  276;  life  history  of,  285;  malaria- 
bearing,  277;  measures  against,  283; 
protection  from,  132,  295;  to  be  kept 
from  sick,  296. 

Mosquito  net,  use  on  march,  113. 

Mouth,  care  of,  25. 

Mucous  membranes,  natural  defenses, 
208. 

Mumps,  255;  cause,  256;  incubation 


INDEX 


349 


period,   265;   second   attacks,   257; 
when  contagious,  266. 

Nervous  system,  diseases  of,  337-343; 

syphilis  of,  328. 
Neuritis,  caused  by  infections,  341. 
Notification  of  cases  of  sicknees,  247, 

270,  305. 

Occupation,  as  predisposing  to  disease, 

154. 
Oil,  to  destroy  mosquito  larvae,  291; 

application  to  water,  292. 
Oysters  and  typhoid,  237. 

Paralysis,  due  to  syphilis,  328;  due  to 
diphtheria,  341. 

Paralysis,  infantile,  255;  and  stable- 
fly,  257;  carriers  of,  188,  260;  incuba- 
tion period,  265;  more  common  in 
warm  weather,  257. 

Paratyphoid  fever,  225. 

Pasteurization,  184. 

Pellagra,  insanity  as  symptom  of,  342. 

Penis,  abnormalities  of,  15. 

Pension,  notation  of  grounds  for,  19. 

Personal  hygiene,  21. 

Petroleum,  crude,  as  pit  dressing,  99; 
to  destroy  mosquito  larvae,  291;  in 
urinals,  64. 

Phenol,  antiseptic  and  disinfectant, 
219. 

Piles,  7,  8. 

Plague,  275,  298;  cause,  298;  in  rats, 
195;  in  squirrels,  196;  method  of  in- 
fection, 201,  298;  notification  of 
cases,  305;  pneumonic,  in  Manchu- 
ria, 196,  299;  prevention  of,  302- 
306;  spread  of,  195;  transmission  of, 
299. 

Pock.   See  Syphilis.  ' 

Poisoning,  by  various  substances,  166; 
metallic,  46;  ptomaine,  57,  167;  self-, 
167;  tyrotoxicon,  45;  wood  alcohol, 
29. 

Policing,  poor,  predisposing  to  disease, 
159;  and  typhoid,  250;  to  prevent 
disease,  215. 

Poliomyelitis.   See  Paralysis,  infantile. 

Predispiosition  to  disease,  147. 

Pressure  as  cause  of  disease,  163;  at- 
mospheric, 164. 

Prevention,  of  beri-beri,  34;  of  gonor- 
rhoea, 321;  of  mosquito-borne  dis- 
ease, 284;  of  nervous  and  mental  dis- 


eases, 336;  of  plague,  302;  of  relaps- 
ing fever,  308;  of  scurvy,  135;  of 
syphilis,  330;  of  typhoid,  244;  of 
typhus,  308. 

Prostitutes,  315;  prevalence  of  dis- 
ease among,  316. 

Proteids,  33. 

Ptomaines,  as  disease  producers,  167. 

Pyrethrum,  fumigation  with,  294. 

Quarantine,  to  prevent  disease  spread, 
214;  meaning  and  use  of,  215. 

Quinine,  as  specific  remedy,  221;  to 
prevent  malaria,  297. 

Race,  as  predisposing  to  disease,  152. 

Rats,  and  plague,  195,  201,  299;  meas- 
ures against,  302. 

Reaction  to  irritation  as  defense 
against  disease,  209. 

Reclamation  of  swamps,  286. 

Recruit,  the,  3;  character  of,  18;  ex- 
amination of,  3-19. 

Relapsing  fever,  275;  and  lice,  306;  of 
Africa,  and  ticks,  275,  309;  preren- 
tion  of,  308. 

Respiratory  tract,  infection  by  way  of, 
255. 

Rest,  need  of,  20. 

Rheumatism,  gonorrhoeal,  319. 

Ringworm,  17,  130;  transmission  of, 
22. 

River  fever,  275;  and  camp-sites,  76; 
and  mites,  275. 

Roaches,  protection  from,  52;  and 
cholera,  239. 

Round  worms,  171. 

Salt  water,  breeding  of  mosquitoes  in, 
284. 

Salts,  food  value,  34;  formation  of,  in 
iirinals,  64. 

Sand-fly  fever,  275.  309. 

Sanitary  soldier  for  each  company, 
101. 

Scarlet  fever,  255;  carriers  of,  188,  260; 
cause  of,  258;  incubation  period, 
265;  second  attacks,  257;  when  con- 
tagious, 266. 

Schistosomum  disease,  169. 

Screening  of  houses,  295. 

Screw  worms,  176,  275. 

Scurvy,  in  cold  climates,  135;  and 
vitamines,  34,  35. 

Seasickness,  120. 


860 


INDEX 


Season,  influence  on  oocurrence  of  dis- 
eaee,  256. 

Seat  worms,  172. 

Self-control,  importance  of,  in  preven- 
tion of  nervous  and  mental  disease, 
337. 

Sexual  hygiene  in  tropics,  131 ;  life,  27. 

Shelter  in  camp,  77. 

Shoes  for  cold  climates,  138;  for  march- 
ing, 114;  soiling,  in  camp,  244;  use 
of,  in  tropics,  128. 

Shower  baths,  62. 

Sick  persons,  avoidance  of,  212. 

Sickness,  effect  of,  on  marching,  106. 

Sinks,  kitchen,  care  of,  52. 

Skin,  affections  of,  in  tropics,  130;  un- 
broken, 86  defense  from  disease,  208. 

Sleep,  amount,  21;  conditions  of,  pre- 
disposing to  disease,  159. 

Sleeping  sickness,  179,  308;  and  ner- 
vous system,  342;  and  tsetse  flies, 
275,  308. 

Smallpox,  255;  as  disease  of  childhood, 
256;  and  insects,  275;  incubation 
period,  265;  second  attacks  of,  257. 

Smoking,  effects  of,  29,  111;  in  day 
rooms,  58;  of  meat,  38. 

Snow-blindness,  142. 

Socks,  for  marching,  114. 

Specific  remedies,  221 ;  as  means  of  pre- 
venting disease,  222. 

Spirilli,  182. 

Spitting,  danger  of,  26;  promiscuous, 
29,  59. 

Spores,  resistance  of,  183. 

Spotted  fever  of  Montana,  275,  309. 

Sputum,  as  source  of  infection,  261. 

Staphylococci,  182. 

Starches  and  sugars,  34. 

Stegomyia  fascicUa,  279;  breeding- 
places,  284;  description  of,  282. 

Sterilization,  means  and  methods,  216. 

Stoves,  68. 

Streets,  in  camp,  78. 

Streptococci,  182. 

8trictiu"e  of  urethra,  319. 

Sulphur,  fumigation  with,  217. 

Sunlight,  as  destroyer  of  bacteria,  184. 

Swamps,  drainage,  286;  reclamation, 
286. 

Syphilis,  324-331;  as  cause  of  aneu- 
rism,insanity, locomotor  ataxia,  328; 
cause  of,  179,  324;  hereditary,  325; 
incubation  period,  325;  indications 
of,  for  examiner,  9,  10,  11,  12, 14, 17; 


period  of  contagiousness,  328;  mar- 
riage after,  329. 

Tabardilla  and  typhus,  306. 

Tapeworms,  169;  life  history  of,  170; 
transmission  of,  37. 

Teeth,  care  of,  25. 

Tetanus,  182. 

Texas  fever,  in  cattle,  202. 

Three-day  fever,  309. 

Ticks,  carriers,  of  African  relapsing 
fever,  309;  of  spotted  fever,  310. 

Toilet  articles,  individual  use  of,  62; 
transmission  of  disease  by,  22. 

Tonsillitis,  255;  causes  of,  256,  267;  in- 
cubation period,  265;  contagious, 
267. 

Toxins,  as  cause  of  disease,  185. 

Training,  faulty,  and  disease,  151;  and 
insanity,  336. 

Trains,  troop,  120. 

Transport  ships,  119. 

Trauma,  exciting  cause  of  disease,  162; 
of  mental  and  nervous  trouble,  342; 
predisposing  to  disease,  153. 

Trembles,  in  cattle,  37. 

Treponema,  localization  of,  329;  and 
syphilis,  324. 

Trichina,  57;  life  history,  174. 

Tropics,  hygiene  of,  122-132. 

Trypanosomes,  and  sleeping  sickness, 
200. 

Tsetse  fly,  relation  to  sleeping  sickness, 
275,  308. 

Tuberculosis,  in  cattle,  199;  carriers  of, 
189;  in  company  cook,  51;  indication 
of,  14;  transmission  of,  26,  37,  44, 
197,  199. 

Typhoid,  and  nervous  disease,  341; 
carriers  of,  189,  229,  230,  233 ;  cause 
of,  225;  contact  infection,  241;  dust- 
borne,  238;  early  diagnosis,  245;  fly- 
borne,  238;  from  shell-fish,  237;  ice- 
borne,  235;  incubation  period,  248; 
isolation  of  cases,  246;  methods  of 
transmission,  228;  mild  cases,  229; 
milk-borne,  236;  prevention,  244; 
route  of  infection,  224;  transmission 
of,  22,  51;  vaccine,  254;  water-borne, 
233. 

Typhus  fever,  306;  and  lice,  275;  and 
nervous  disease,  341;  how  transmit- 
ted, 306;  prevention,  308. 

Uncinariasis.   See  Hookworms. 


INDEX 


851 


Uncleanlinesa,  predisposing  to  disease, 

159. 
Urinals,  64,  67. 

Urination,  careless,  danger  of,  26. 
Urine,  disposal  of,  in  camp,  100. 
Utensils  as  means  of  infection,  262; 

carriers  of  disease,  61. 

Vaccination,  as  cause  of  immunity, 
210;  to  prevent  cholera,  253;  dysen- 
tery, 253;  plague,  305;  smallpox,  273; 
typhoid,  254. 

Varicocele,  16. 

Vegetables,  41;  and  disease,  236. 

Veins,  varicose,  of  leg,  13;  of  abdomen, 
7. 

Venereal  disease,  carriers  of,  190,  312; 
general  causes  of,  314;  general  meas- 
ures of  prevention,  314;  mixed  in- 
fections of,  330;  prevalence  in  army, 
313;  urine  as  defense  against,  209. 

Ventilation,  in  prevention  of  disease, 
213,  268;  in  very  cold  climates,  134; 
of  barracks,  56,  59,  68. 

Vermin,  exclusion  from  kitchen,  52,  55; 
guarding  against,  to  control  epidem- 
ics, 269;  in  barracks,  72;  in  camp, 
78;  on  recruit,  11,  16,  17,  22;  on 
transtwrts,  119. 


Vibrios,  182;  of  cholera,  226. 

Vitamines,  34. 

Voit's  food  standard,  35. 

Walls,  damp,  avoidance  of,  55. 

Wassermann  reaction  in  syphilis,  329. 

Water,  and  disease,  26,  234,  252;  drink- 
ing-, in  tropics,  123;  purification  of, 
80,  110;  use  on  march,  108. 

Water-closets,  57,  63. 

Water-supplies,  65,  80,  234,  252. 

Weight  carried,  and  effect  on  marchicK, 
105. 

Wet  dreams,  27. 

Whip  worms,  172. 

Whooping  cough,  255;  cause  of,  256; 
in  animals,  200;  incubation  period, 
265;  second  attacks,  257;  when  con- 
tagious, 266. 

Wind,  regard  for,  in  placing  buildings, 
55. 

Worms,  in  feces,  64;  intestinal,  172. 

Yellow  fever,  275;  eradication  from  old 
haunts,  280;  incubation  period,  280; 
mosquito,  description  of,  282;  mos- 
quito transmission  of,  279;  natural 
history  of,  280;  prevention,  284; 
when  dangerous  to  others,  281. 


(3Cbe  Ifiiteriiibe  J^re^^ 

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